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Thread: 90696 for less than 4 years old

  1. #1

    Default 90696 for less than 4 years old

    AAPC: Back to School
    90696 is a new code in 2009 but what about if the patient is less than 4?

  2. #2
    Join Date
    Apr 2007
    North Carolina


    It seems you have to use an unlisted code...Any other takers?

    You Be the Coder: DTaP-IPV Booster Receives Own Code

    Question: What is the CPT code for Kinrix?

    Answer: You should use new code 90696 (Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated [DTaP-IPV], when administered to children 4 through 6 years of age, for intramuscular use) with V06.3 (Need for prophylactic vaccination with diphtheria-tetanus-pertussis with poliomyelitis [DTp + polio] vaccine). CPT 2009 established the code to report a combination vaccine to protect against pertussis (whooping cough), diphtheria, tetanus, and poliomyelitis (polio) in a single injection.

    Kinrix combines the DTaP (diphtheria, tetanus toxoids, and acellular pertussis) and IPV (poliovirus inactivated) vaccines. You previously had no code that represented this combination. Because CPT disallows coding each component of a combination vaccine separately, such as reporting the DTap portion with 90700 (Diphtheria, tetanus toxoids, and acellular pertussis vaccine [DTaP], when administered to individuals younger than 7 years, for intramuscular use) and the IPV component as 90713 (Poliovirus vaccine, inactivated [IPV], for subcutaneous or intramuscular use), you had to use an unlisted procedure code (meaning 90749, Unlisted vaccine/toxoid), per CPT’s "Vaccines, Toxoids" instructions.


  3. #3
    Join Date
    Apr 2007



    "Safety and efficacy not established in children younger than 4 yr of age or children 7 to 16 yr of age."

    According to this it is not meant for any other age range.

    Laura, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    North Carolina



    What was your vaccination combination?

  5. #5
    Join Date
    Apr 2007
    North Carolina


    Indications and Guidance for Use

    DTaP-IPV (Kinrix) is indicated for use as the fifth dose of DTaP and fourth dose of IPV in children aged 4 -- 6 years who received DTaP (Infanrix) and/or DTaP-Hepatitis B-IPV (Pediarix) as the first 3 doses and DTaP (Infanrix) as the fourth dose (1,2). This vaccine should not be administered to children aged <4 years or >7 years; however, if DTaP-IPV (Kinrix) is inadvertently administered for an earlier dose of the DTaP and/or IPV series, the dose should be counted as valid and does not need to be repeated provided minimum interval requirements have been met (5). Data are limited on the safety and immunogenicity of interchanging DTaP vaccines from different manufacturers (6). ACIP recommends that, whenever feasible, the same manufacturer's DTaP vaccines should be used for each dose in the series; however, vaccination should not be deferred because the type of DTaP previously administered is unavailable or unknown (6).


    If it is inadvertently administered, would this be payable? Anyone know?

  6. #6


    I have a patient who was 2 days shy of his 4th birthday, when he got this 90696, which is denying "due to patient's age". Is there any way to get this paid? I'm not seeing it. I don't see any other immunization combo that fits, for younger than age 4 (and he's still 3years old until he's 4!) It looks like the denial is going to stick, unless someone has an idea for me. Thank you.

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