90696 for patients outside of 4-6 years old

Agilbert3

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Local Chapter Officer
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SHREVEPORT/BOSSIER CITY
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Hello,

The nurse at our clinic who administers vaccines sometimes admins a 90696 for kids outside of the 4-6 age rage. She says it's due to patients being behind on their vaccines and circumstances like that.

Can I code this a a DTaP 90700 and IPV 90713 separately? Or do I have to use the 90696?

I'm the only certified coder and I'm new myself, so any help would be greatly appreciated.
 
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90696

The introductory text to the vaccine codes explains that the "when administered to" age descriptions included in CPT code descriptions are not intended to identify a product's licensed age indication. This, though not clearly stated, was included to indicate that though ages are still included in some code descriptors; the ages in the code descriptor do not limit the proper administration to patients younger/older than the code describes and does not limit reporting of the appropriate code describing the vaccine product/dose administered. Ages are typically not included in descriptors for newer codes.

It would not be appropriate to report codes for separate vaccine products when a combination vaccine was provided.

I hope this is helpful.
Cindy

Hello,

The nurse at our clinic who administers vaccines sometimes admins a 90696 for kids outside of the 4-6 age rage. She says it's due to patients being behind on their vaccines and circumstances like that.

Can I code this a a DTaP 90700 and IPV 90713 separately? Or do I have to use the 90696?

I'm the only certified coder and I'm new myself, so any help would be greatly appreciated.
 

MrLittlefoot

Contributor
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21
Location
Spokane valley, WA
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With that said. If you are billing for these vaccines(the only 2 i'm aware of are Kinrix and Quadracel) they actually do have FDA indicated ages of 4-6. You will run into carriers that will refuse to pay for them outside of the range and indicate that they are either not age appropriate or experimental(as the FDA hasn't specifically approved them for someone of that age per the package insert) so you may want to check with the specific insurance carriers you regularly deal with to determine their specific policy so you can inform patients prior to administration of these vaccines if their insurance won't pay them.
 
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