What Is CPT Code 90677 and How Is It Billed?
Demystify CPT Code 90677. Learn its meaning, administration guidelines, and critical billing requirements for accurate healthcare coding.
Current Procedural Terminology (CPT) codes serve as a standardized language for medical services and procedures, facilitating communication and billing within the healthcare system. These codes are essential for healthcare providers to accurately describe the services rendered to patients. CPT code 90677 represents a specific vaccine product, crucial for public health efforts. This code helps ensure proper documentation and reimbursement for immunization services provided.
Understanding CPT 90677
CPT code 90677 identifies the Pneumococcal Conjugate Vaccine, 20-valent (PCV20), for intramuscular use. This vaccine protects against 20 different strains of Streptococcus pneumoniae, a bacterium causing serious illnesses like pneumonia, meningitis, and bloodstream infections. The vaccine works by stimulating the body’s immune system to produce protective antibodies against these specific bacterial strains. Preventing pneumococcal disease is an important public health objective, as these infections can lead to severe complications, long-term problems such as brain damage, hearing loss, or even death.
Administration and Patient Eligibility
The PCV20 vaccine is recommended for various age groups and individuals with specific health conditions. It is routinely administered to infants and young children, typically in a series of doses starting at two months of age. Older children and adolescents may also receive this vaccine if they missed earlier doses or have certain medical conditions.
For adults, the vaccine is recommended for individuals aged 65 years and older, as well as those aged 19 through 64 years with particular chronic health issues. These conditions can include chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, or weakened immune systems due to conditions like HIV infection or certain cancers. Healthcare providers such as doctors, nurses, and pharmacists administer the vaccine.
Billing and Documentation Essentials
Accurate billing for CPT code 90677 requires precise documentation to support the medical necessity of the vaccine. Essential details to record include the date of administration, the vaccine manufacturer and lot number. The route and anatomical site of administration must also be noted in the patient’s medical record. Providers must also document the date the Vaccine Information Statement (VIS) was provided to the patient or guardian.
When billing, CPT code 90677 covers the vaccine product itself, and a separate administration code is typically used to bill for the act of administering the vaccine. For billing purposes, CPT 90677 should be linked with appropriate diagnosis codes, such as Z23 (Encounter for immunization), to justify the service. Many payers also require the inclusion of the National Drug Code (NDC) for the vaccine product on the claim form.