Pediatric Coding Alert

Question: How do we code for a child who comes to the office for a flu shot (administered by a nurse), but also sees the pediatrician to receive a clean bill of health? That is, the patient may have had a recent physical but the doctor meets with the child because there is some question of illness. We usually code 99211 plus the flu shot, but I would like a more appropriate code for the physician services.

Kentucky Subscriber

Answer: Although frequently referred to as a nurse visit, 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) can be used for a physician visit as well. If the level of service provided by the pediatrician who declares a clean bill of health does not qualify as a 99212 (office or other outpatient visit for the evaluation and management of an established patient) that is, it does not meet two of the three key components (history, exam and medical decision-making) required for a level-two evaluation and management service you cannot bill 99212. Code 99211 is, therefore, appropriate for some physician services.