# Flu Shots- told by the doctor to bill



## michaelrcpc (Sep 23, 2010)

We are being told by the doctor to bill for a level 1 with each of the flu shots. Is this correct? When is it appropriate to bill a level 1 with a flu shot and when is it not? What documentation is needed? And will this work? Thanks


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## cmcgarry (Sep 27, 2010)

We do not bill a level 1 (99211) visit with the flu shots.  We bill the administration and the vaccine.  If there is physician counseling involved, then use the administration codes that include the physician counseling.

Only bil a visit if a separately identifiable E/M is performed.


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## mitchellde (Sep 27, 2010)

Cindy is correct, when a patient presents for a scheduled service then you may not charge a E&M for that service or in addition to that service when a CPT code is available for the service.  A flu shot is a service the patient schedules for and the assessment for the necessity has already been performed.  So you may charge for the admin and the vaccine only.  If the patient has an additional complaint then there needs to be a physician encounter in addition to the admin code.


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## akeady (Sep 27, 2010)

Do you have to charge both the admin charge and vaccine or can we just post the vaccine? I am asking because we have just a flat fee that we charge for flu shots?


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## chelebell59 (Sep 27, 2010)

you have a flat fee for people that are self pay.... but if you are billing the ins then you would bill for the cpt flu shot and the admin or injection code...


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## heatherwinters (Oct 1, 2010)

*Flu Shots*

_http://www.physicianspractice.com/display/article/1462168/1586720
_


> _No 99211 for flu shots
> _Can I code for a 99211 when I give an injection — say, a flu shot — if I also am checking vitals?
> You  should not use the 99211 when delivering a flu shot if you are taking  routine vital signs. Verifying that a patient is "OK" for a flu shot and  making sure the patient is all right before leaving the office are  components of the administration code. There are many payers that will  not pay for code 99211 in conjunction with an injection code for just  this reason. This code is actually a red flag for many payers since it  is often misused. Instead, code just for the appropriate administration  code (90471-90472) and the flu vaccine.


*Service Is Medically Necessary*
*Question 4:*  Suppose a patient presents for a flu shot and also complains of a cough  and congestion. Under office protocol, the nurse assesses the patient’s  complaints, determines administering the vaccine presents no  contraindications, and goes ahead with administration. Would 99211 be  appropriate in this instance?


http://codingnews.inhealthcare.com/...it-proof-your-incident-to-99211-nurse-visits/



> *Answer 4: *Yes,  because the nurse, under a physician’s orders, performs a medically  necessary E/M to evaluate the patient’s chief complaint before  administering the shot, you can bill 99211-25 (_Significant,  separately identifiable evaluation and management service by the same  physician on the same day of the procedure or other service_).
> 
> *Watch out:* Buechner cautions the nurse must document the rationale for medical necessity, and that the E/M that supports the service.


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## kumeena (Oct 1, 2010)

Usage of CPT code 99211

scenerio1: We have a* walk-in clinic *( no appointment necessary) in our facility.Nurse counsel and administer the vaccine

Scenerio2atient was seen by physician and he ordered for flu  shot.Unfortunately it is out of stock.when we get medication nurse recall the patient. patient comes in *(walk-in/no [/B]scheduled appointment)

Please advise me is it appropriate to use 99211*


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## RebeccaWoodward* (Oct 1, 2010)

I agree with the others.  If the sole purpose is to receive the vaccination, 99211 is not appropriate.

*Where the sole purpose of an office visit was for the patient to receive an injection, payment may be made only for the injection service (if it is covered)*

http://www.cms.gov/manuals/downloads/clm104c17.pdf

*Section 20.5.7*


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