# Billing a Prevenative office visit along w/ vaccines



## Irma (Oct 27, 2009)

My daughters peditritian billied a prevenative office visit along w/ the adminstration of the flu vac and the flu vacc itself.  The physician did not see my daughter.  The nurse took vitals and administered the vaccine.  Is this allowed?  Can you bill out a prevenative office visit if the MD does not see the patient?


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## RebeccaWoodward* (Oct 27, 2009)

Wow...What codes did they bill?  Did you bring it to their attention?


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## Irma (Oct 27, 2009)

Irma said:


> My daughters peditritian billied a prevenative office visit along w/ the adminstration of the flu vac and the flu vacc itself.  The physician did not see my daughter.  The nurse took vitals and administered the vaccine.  Is this allowed?  Can you bill out a prevenative office visit if the MD does not see the patient?



I beleive they billed out the following, 

99393
90471
90658

and receieved reimbursement for all procedures.  What do you think?  Is this right eventhough the physician signs off on the chart note.


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## dmaec (Oct 27, 2009)

I think...that there'd better be documentation supporting that well child visit! or they just might be in trouble!!  
AND... I'd ask for a copy of the office note, just to see what exactly they say they did to deserve that E/M preventive code being billed/coded out.

a nurse visit for the administration of a vaccine,...alone... the ONLY reason they're coming in... should be billed/coded with the vaccine/admin code & dx.  

some places DO code out a 99211 along with that... (we don't)


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## mitchellde (Oct 27, 2009)

A nurse cannot perform the elements of a well child visit even if the physician does sign off on the note, even if he pokes his head in the door and says hi!!  While some still do code a 99211 for injections it is still stated that is not allowed since a code exists for the administration of the vaccine, and vitals and nurse supervision of the patient is all part of the administration code.   I hope this was just a single isolated coding error.


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## RebeccaWoodward* (Oct 27, 2009)

Personally, I would *LOVE* to see this documentation...  You're entitled to that medical record....ask for it...


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## mitchellde (Oct 27, 2009)

I absolutely agree!  It will make interesting reading for sure.


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## Irma (Oct 28, 2009)

Thank......All your input was very helpful


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## encomma-watson (Oct 28, 2009)

*Preventative Office Visit along with vaccines*

How is he able to bill that?  I know that you were in the room with your child.  It should have been billed a 90471 and the flu vaccine, if the pt was not seen by a md.  depending on the insurance, especially with MCD, you cannot bill a 99211, a 90471 and a vaccine code, MCD will pay the higher reimbursment whether it is the 99211 or the administation code.  Good luck.


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