EM Coding Alert
Flu-Shot-Only New Patients Pose Coding Challenges
Question: We are trying to decide how to handle new patients who want to come in just for a flu vaccine. The patient declines a well visit because it “isn’t due yet” (insurance wouldn’t cover an “extra” check-up), but we are not comfortable bringing in a totally new patient to just have a medical assistant do a vaccine. We want them to see a doctor for a brief visit to establish the patient, and then have the medical assistant do the vaccine. How can we collect for this?
Alabama Subscriber
Answer: Typically if it is a new patient, the insurance will pay for the “additional” preventive medicine visit, even if it occurs at less than a one year interval.
If not, the practice will either provide a brief preventive medicine visit at no charge as a practice builder, or bill a reduced preventive medicine visit (52 modifier) which the family will be responsible for paying out of pocket. In this situation, having the family sign an advance beneficiary notice (ABN) is optimal to avoid any misunderstanding.
EM Coding Alert
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