How to Ethically Report Nurse Visits With Immunizations

And be sure you avoid this one common pitfall at all costs
Although you might be tempted to “write off” a 99211 charge when billed on the same day as an immunization administration, don’t give in. You can get reimbursed for both codes as long as the encounter involved a significant, separate problem unrelated to the procedure.

Knowing when you’re able to code for both the E/M and the procedure is a trick issue that stumps many coders. “If we make an appointment, pull and prepare the chart, obtain a history, and prepare and administer the vaccine with chart documentation, should we bill for 99211?” asks Debbie Argo, office manager at Family Care of Kent in Kent, Wash.
 
Look for this information when determining whether you should bill 99211 with 90465-90474.
CC, Problem Justify Separate E/M
You should report a medically necessary E/M that is significant and separate from the immunization encounter. “When the provider (usually the nurse) evaluates, manages and documents a complaint(s) or problem(s), you can justify the additional reporting of CPT 99211,” says Steven M. Verno, CMBSI, CMMC, CMMB, NREMTP, compliance director with the Medical Association of Billers.
 
To identify a stand-alone 99211, you can check for these bullets. The nurse typically:

• conducts a brief history

• performs a chart review along with a physical assessment (such as indicated vital signs and observations)

• provides patient education in helping the family or patient manage the problem encountered.
Key: “These nursing activities are all directly related to the significant, separate complaint and are unrelated to the actual vaccine administration,” Verno says.
Different Diagnoses Solidify Billable Service
Looking at the diagnoses can help you spot a service that warrants coding a nurse visit. “Additional diagnoses on the encounter sheet should alert you to report 99211 with modifier 25,” says Maria M. Torres, CPC, CMM, CCC, CMSCS, a primary-care consultant with Bermudez Medical Consulting Services in Tampa, Fla.

Why: Using different diagnoses helps show the payer that the nurse’s service is medically necessary and separate from the vaccine administration. CPT, however, does not require you to report a separate ICD-9 code for the visit and the immunization administration.
E/M, Procedure Notes Demonstrate 99211
If you can draw a line between the E/M service and the vaccine administration, you can safely bill 99211. A separate nurse visit should include the following documentation:

• the date of service

• the reason for the visit (chief complaint or CC)

• a brief history of any significant problems the nurse evaluates or manages

• any examination elements (such as vital signs or appearance of a rash)

• a brief assessment and/or plan along with any counseling or patient education

• signatures of the nurse and supervising physician.

The nurse should record the [...]

- Published on 2005-09-18