Pneumovax 23 Q&A

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Question

Since update on coding of Pneumococcal vaccines status as "up to date" in 2019, if patient just had the PPVS23 is that considered up to date in accordance with ACIP guidelines?

Answer

Presently, the Pneumococcal Vaccine CDC/APIC guidelines:

 

  • For most people over 65:

 

    • One dose of Pneumovax 23 after the age of 65
    • One dose of Prevnar 13.
    • For people over the age of 65 who have had neither vaccine, it is recommended that Prevnar 13 is given first, but
    • It does not have to be the Pneumovax 23 or Prevnar 13 first.
  • Example:  Prevnar came out in 2010. It is possible that a person received the Pneumovax 23 in 2008 when they were 66. Prevnar 13 was not available yet. Now, in 2021, they are 79.  They would only need the Prevnar 13 to be up to date.

 

    • Regardless of which vaccine was given first, for most persons over 65 it is recommended to wait one year between administering Prevnar 13 and the Pneumovax 23.

 

    • If the person received the Pneumovax 23 before the age of 65, there should be 5 years between the first dose and second.

 

    • Example:
  • The individual received one dose of Pneumococcal 23 at the age of 63.  At the age of 65, they receive Prevnar 13.  They should not receive the second dose of Pneumococcal 23 until they are 68, when 5 years have passed since the first. This person would be considered up to date until they are 68, when the Pneumovax 23 could be administered.

 

    • Example:

 

      • If the individual received Pneumococcal Vaccine 23 at age 66, and have never received Prevnar 13, and at least a year has passed since they received the Pneumovax 23, they need Prevnar to be up to date.

 

    • Example:

 

      • If they are over age 65 and never received any Pneumococcal vaccine, and the facility gave the Prevnar 13, then they will be up to date until the year passes and the Pneumovax 23 can be given.  Once the year passes, then they would need to be vaccinated to be considered up to date.

 

    • Example:

 

  • If the individual has never received any Pneumococcal vaccine(either one) after the age of 65,

 

o   Prevnar is recommended first,

o   Followed by the Pneumovax 23 one year later.

 

For persons under the age of 65 and for persons who are considered high risk, the recommendations are different.

 

  • For people under the age of 65:

 

    • Pneumovax 23 is recommended first,
    • Prevnar 13 after they turn 65,
    • Followed by Pneumovax 23 a year later 

 

    • Example:
  • The 60-year old individual received Pneumovax 23 at the age of 52. They are up to date until the age of 65, when the “after age 65” recommendations take effect.

 

  • For persons considered to be “high risk:”
  • “High risk” includes immunocompromising conditions, Cerebrospinal fluid leaks, or persons with Cochlear Implants.
  • APIC recommends persons considered to be “high risk” receive the Prevnar 13 vaccine followed by the Pneumovax 23 with 8 weeks in between vaccinations.

 

To properly code Section O of the MDS, it is important to know the person’s vaccination history. Obtaining vaccination history from the Primary Care Provider supports an accurate vaccination history in the medical record.

 

Also, for Medicare beneficiaries, the Fiscal Intermediary Shared System (FISS) report will have a record of any vaccination that was billed to Medicare in the Preventative Healthcare section.




Harmony Healthcare International (HHI) is hosting our 9th Annual Long-Term & Post-Acute Care (LTPAC) Interdisciplinary Symposium Thursday, October 21st, and Friday, October 22nd, 2021 at the Encore Boston Harbor resort and casino. Click below to register and for more information!

Click Here to Register for harmony21

harmony21 website
 

Harmony Healthcare International (HHI) is available to train your staff on MDS. HHI is happy to present you with our 8-week MDS Bootcamp Level 1 hosted virtually for 1-hour each Wednesday, September 15, 2021 - November 3, 2021, from 1:00 P.M. EST – 2: 00 P.M. ESTThis weekly MDS Bootcamp will cover Medicare Entitlement, Eligibility and Coverage Criteria, Medicare Process, and more! Click below for more information and to register.

Click Here to View MDS Bootcamp Level 1

 

If you are already enrolled in the MDS Bootcamp Level 1, check out the next Level of our MDS Bootcamp Level 2 below! This will be hosted virtually for 1-hour each Wednesday, September 15, 2021 - November 3, 2021 from 2:00 P.M. EST – 3:00 P.M. EST.

Click Here to View MDS Bootcamp Level 2

 

 
 

Topics: SNFs


Kris Mastrangelo, OTR/L, LNHA, MBA

WRITTEN BY

Kris Mastrangelo, OTR/L, LNHA, MBA
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