Otolaryngology Coding Alert

Don't worry too much because new rule won't lead to denials, experts say

If you-re reporting nurse visits in addition to immunization codes 90465-90474, you-ll soon start seeing denials pour in. NCCI 12.0 bundles the codes for  immunization administration for vaccines and toxoids with 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician), and you can't break the bundles.

Note: You shouldn't have to worry about these edits causing coding problems for your allergy practice, however. Medicare doesn't recognize codes 90465-90474 for their limited immunization coverage (flu, pneumo, Hepatitis B), says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. Medicare only covers other immunizations if the beneficiary received it in response to illness/injury (eg., a tetanus shot, 90703).

Typically, the patient would be experiencing a new problem, which would warrant a visit by the physician or other advanced practitioner, not the nurse.

For example, if the patient has an injury and your physician administers a tetanus shot, you should report 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]), 90703 (Tetanus toxoid absorbed, for intramuscular use), and the code representing the most appropriate E/M service.