90714

Tetanus and Diphtheria Toxoids (Td) Adsorbed, Preservative Free, 7 Years or Older, IM Use

CPT code 90714 describes a vaccine product used for active immunization against tetanus and diphtheria in individuals who are seven years of age or older. This specific formulation is defined as being 'adsorbed' and 'preservative free.' Adsorption refers to the process where the toxoids are attached to aluminum salts, which serves as an adjuvant to enhance the body's immune response to the antigens. Being preservative-free, this vaccine does not contain substances such as thimerosal, making it suitable for patients with specific sensitivities or according to certain state mandates and clinical preferences. Tetanus, often called 'lockjaw,' is a severe disease caused by the toxin produced by Clostridium tetani bacteria, usually entering through deep cuts or puncture wounds. Diphtheria is a contagious bacterial disease caused by Corynebacterium diphtheriae that can lead to respiratory obstruction and systemic complications. The 90714 vaccine is commonly utilized for decennial boosters (every 10 years) or as part of wound management for patients who have not completed a primary series or whose last booster was over five years ago. It is important to note that this code represents the vaccine product only; the clinician must report the actual administration of the vaccine using the appropriate immunization administration codes (such as 90471 or 90460). Documentation should reflect the manufacturer, lot number, and that a Vaccine Information Statement (VIS) was provided to the patient or guardian.

Clinical Indications

  • Routine booster vaccination for tetanus and diphtheria every 10 years in adults and adolescents.
  • Tetanus prophylaxis in wound management for patients with incomplete or unknown immunization history.
  • Tetanus prophylaxis for patients with a clean, minor wound if the last dose was more than 10 years ago.
  • Tetanus prophylaxis for patients with contaminated or deep wounds if the last dose was more than 5 years ago.
  • Catch-up immunization for individuals 7 years or older who did not complete the primary series.
  • Active immunization against diphtheria in susceptible individuals 7 years of age or older.

Procedure Steps

  1. Verify the patient's identity and confirm they are at least 7 years of age.
  2. Screen for contraindications such as previous severe allergic reaction to any component of the vaccine or a history of Guillain-Barré syndrome.
  3. Provide the patient or legal guardian with the most current Tetanus/Diphtheria (Td) Vaccine Information Statement (VIS).
  4. Inspect the vaccine vial for any particulate matter or discoloration; the vaccine should be a cloudy, white suspension.
  5. Shake the vial or prefilled syringe thoroughly to maintain the suspension of the adsorbed toxoids.
  6. Withdraw a 0.5 mL dose from the vial using a sterile needle and syringe, or prepare the prefilled syringe.
  7. Identify the injection site, typically the deltoid muscle for adolescents and adults.
  8. Cleanse the site with an alcohol swab and allow to dry.
  9. Administer the vaccine via intramuscular (IM) injection at a 90-degree angle.
  10. Apply pressure and a bandage if necessary, and dispose of the needle and syringe in a sharps container.
  11. Document the date of administration, site, manufacturer, lot number, and VIS date in the medical record.

Coding Guidelines

  • Code 90714 represents the vaccine product only. Always report a separate administration code (e.g., 90471, 90472, 90460, 90461) to receive payment for the procedure.
  • Do not use 90714 if the vaccine administered includes the acellular pertussis component (Tdap); use 90715 instead.
  • This code is strictly for patients 7 years of age and older. For younger children, DTaP (90700) or other pediatric combinations are typically used.
  • The 'preservative-free' status must be supported by the documentation and the specific product NDC (National Drug Code) used.
  • If an Evaluation and Management (E/M) service is provided in addition to the immunization, use modifier 25 on the E/M code only if the service is significant and separately identifiable.
  • Medicare coverage for Td (90714) is usually limited to injury-related prophylaxis (Part B) or routine preventive care under Part D, depending on the plan.

Associated ICD-10 Codes