# billing 99212 with immunizations



## JAMES (Jan 24, 2011)

I had a 12 year old pt come in with paper from her school stating that she needed a varicella and tdap. She had not been at our clinic since 2009. She had however been seen within the last year by another physician for her preventive service. Our doctor did vitals, heart, lung, check and spent 10 mins going over her immunizations and discussing with her parent the vaccines she would be getting. Can we do a 99212 along with her administration and vaccines, and what icd9 would you append to the office visit.


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## btadlock1 (Jan 25, 2011)

JAMES said:


> I had a 12 year old pt come in with paper from her school stating that she needed a varicella and tdap. She had not been at our clinic since 2009. She had however been seen within the last year by another physician for her preventive service. Our doctor did vitals, heart, lung, check and spent 10 mins going over her immunizations and discussing with her parent the vaccines she would be getting. Can we do a 99212 along with her administration and vaccines, and what icd9 would you append to the office visit.



You wouldn't use 99212 unless the patient had signs or symptoms of a problem that was addressed during the visit. 99212 is a problem-oriented E/M code. If your charges are from 2010 and you've got adequate documentation, I would defer to 99394 for this situation, since the vaccine admin codes for a patient this age specify that physician counseling is not required/included, therefore the counseling and exam you mentioned would be in addition to the vaccine administration. I'd report 99394, 90471, and 90472 (if 2 separate shots were given), + your vaccine codes. For the E/M, I'd use V70.3 to indicate "school physical", and the V-code(s) that reflect the vaccines provided.

If it's a 2011 DOS, I'd use caution when reporting a separate E/M, since CPT's 90460 and 90461 are intended for use for patients under 18 receiving vaccines* with physician counseling*. Your history and exam documented may not have enough elements covered to support 99394 without taking the counseling into consideration. You need to go above and beyond the usual pre- and post-service work associated with the vaccine admin's definition to report an E/M code in addition to a physician's service. 

In either situation, if you decide to report 99394 for the encounter, it shouldn't require a modifier to keep from bundling to your vaccine admin codes; however, some payer claims edit systems will still deny the charge without one (just because they can). Even though the modifier isn't technically required per CPT guidelines, if you encounter a denial for bundling and are unsuccessful in having the claim reprocessed, you may have to submit a corrected claim with a 25 modifier on 99394 to get it past the edit software with a few insurers. Hope that helps!


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