Pediatric Coding Alert

Question: If our medical assistant sees a new patient for a flu shot only, and the patient does not see the doctor, does it count as a new patient visit? No E/M code is reported during the service. We aren’t sure whether the patient’s next visit (with a doctor) can count as a new patient visit or whether the patient is established following the medical assistant’s flu shot administration.

Codify Subscriber

Answer: You can bill a new patient E/M visit when the patient returns to see the physician. The reason is that to qualify as a “visit,” there must be a provider involved, not just a medical assistant’s service administering a shot.

Caveat: Keep in mind that if a provider such as a doctor, PA or NP performed the counseling portion of the medical assistant’s flu shot during the initial visit, then the subsequent visit would be considered established because a provider was involved in the initial visit.