Citing a significant administrative burden to physicians, the AAFP asked CMS to immediately update its CPT file with code 90714 for tetanus and diphtheria toxoids adsorbed, preservative-free, for intramuscular use in individuals 7 years old or older.
In a September letter to CMS, (then) Board Chair Michael Fleming, M.D., of Shreveport, La., said if CMS waits until January to update the code, as it has indicated it will do, its inaction not only creates added work for physicians but also "violates the requirements set forth by the Health Insurance Portability and Accountability Act of 1996." CPT code 90714 became a valid code on July 1 and, according to HIPAA, covered entities, including CMS, must recognize it starting on that date.
Until CMS loads code 90714 into its system, physicians have been instructed to use an alternative but unlisted CPT vaccine code, 90749, said Fleming in the letter. However, using an unlisted code creates a burden to physicians because "most carriers will require submission of a paper claim along with an accompanying report/office note when unlisted CPT codes are utilized," said Fleming.
"It is particularly frustrating for physicians to be forced to use unlisted codes when a valid CPT code better suited for the service is already in existence," said Fleming.
AAFP also recommended that CMS develop a system that will allow for CPT code updates at least twice a year because CPT codes will continue to be released on a biannual basis.
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