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90700 seven and older

  1. Default 90700 seven and older
    Medical Coding Books
    What's the code if the patient is seven or older?

  2. #2
    Sioux Falls South Dakota
    I would use 90715 (TDaP as opposed to DTaP but the same, just for over 7 yrs of age, IM)
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    North Carolina

    This article is a little old but it does provide some insight to your question. The recommended code is an unlisted code. According to this article, CPT code 90715 is not recommended.

    Q: I am trying to find the vaccine code for DTaP for patients who are over the age of 7 years old. I know that for patients under 7 years old, to use CPT code 90700. I have asked several coders about this, and some of them have suggested using CPT 90715. I did some research and found that DTaP is not the same vaccine as Tdap. Please help with some clarification.

    A: You are correct that the code for DTaP is different from the code for Tdap. Because there is no specific listing for the code that you need, unfortunately, I think you are forced to use the unlisted vaccine/toxoid code for this vaccination and submit a report to the payer.

    I would like to provide this additional advice or information with regards to the question of a CPT code for DTaP vaccine administered to an individual over 7 yrs old. I would definitely not report the specific code for the Tdap (90715) if the DTaP vaccine truly was given. The FDA has approved/licensed Tdap for protection against the three diseases that DTaP provides; however, this vaccine is for adolescents and adults. Tdap is different from DTaP in this way: Tdap is specially formulated with lesser quantities of some of the toxoids. DTaP is not approved for use in individuals over age 7 as there are significant risks for individuals of that age receiving the stated vaccine. Providers should take care in documenting these two different vaccines and ensure that the exact vaccine they administer is what they document.

    Here is further advice concerning a situation where the provider has documented a vaccination performed outside the age specified in the CPT code description. First of all, confirm the exact vaccine that the provider administered. Second, if this first attempt at clarification reveals that the provider administered a vaccine to a patient outside the recommended age range, then I would suggest recommending that the provider follow the practices that the FDA/CDC have established for the use of these vaccines. For the CPT coding aspect of this, I personally would not recommend using the specific code that specifies an age range if that particular vaccine was given to an individual outside that age range. Without any further specific and official advice, I would recommend using the unlisted vaccine code.


  4. Default

  5. #5
    Sioux Falls South Dakota
    I do apologize - I jumped to the conclusion that the correct over age 7 vaccine was administered but the provider or nurse wrote the under 7 (possibly out of habit) in the chart - mainly because that has happened to me on numerous occasions, and I always questioned the nurse as to what was actually given. Rebecca is so right - first verify what was actually given.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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