Outpatient Facility Coding Alert

Question: A 48-year-old female, fearing she has H1N1, reports to the ED complaining of weakness and fatigue; she rates her fatigue at 8 on a scale of 10, saying “I can barely get out of bed.” After a level three E/M that includes a rapid screen, the physician determines the patient does not have H1N1, but is suffering from chronic iron deficiency anemia due to heavy, excessive bleeding associated with uterine fibroids. The patient requests an H1N1 vaccination, which the nurse provides. How should I code this encounter?

North Carolina Subscriber

Answer: You’ll report an E/M for the physician’s services and the facility will code for the vaccination administration. On the claim, report the following:

• 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity...) for the E/M
• 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) or G0008 (Administration of influenza virus vaccine), if Medicare, for the vaccine administration. 
• V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; influenza) appended to 90471/G0008 to represent the patient’s need for vaccination
• 280.0 (Iron deficiency anemia secondary to blood loss [chronic]), appended to 99283 to represent the patient’s uterine bleeding
• 626.6 (Metrorrhagia) appended to 99283 to represent the patient’s uterine bleeding.