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Pneumonia vaccine CPT code

Q: I'd like some clarification on the pneumonia vaccination CPT codes, specifically CPT code 90669 that specifies "children under five years of age." Which CPT code would you use for a child who is exactly five years old?

A: Use the child's date of birth as the cut off. This means that if the provider sees the child on his or her birthday, report 90732. The descriptor for this code specifically states, "...for use in individuals two years and older, for subcutaneous or intramuscular use." Be aware that this is the code for the vaccine material itself and not the administration of the vaccine. Report code 90465 for the administration if the physician also counsels the family/patient. Some payers accept G0009 (administration of pneumococcal vaccine when no physician fee schedule service on the same day).

Editor's note: Linda Martien, CPC, CPC-H, of National Healing, Inc., answered this question.