Pediatric Coding Alert

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.

Expect staff to administer the vaccine "as a booster dose to healthy children 4 to 6 years of age who completed the recommended immunization schedule for DTaP and poliovirus during their infancy," according to CPT Changes 2009 -- An Insider's View. Kinrix is indicated for the fifth DTaP and fourth dose IPV in 4 to 6 year olds whose previous DTaP vaccine doses have been with Infanrix (90700, DTaP) and/or Pediarix (90723, Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine inactivated [DTaP-Hep B-IPV], for intramuscular use).

Beware: The vaccine code's inclusion in CPT 2009 Appendix K, "Product Pending FDA Approval," is a mistake. "Remove 90696 from Appendix K, as this code received FDA approval," according to the AMA's "Corrections Document -- CPT 2009" (www.ama-assn.org/ama1/pub/upload/mm/362/2009cptcorrections-121608.pdf).