Pediatric Coding Alert

Question: A child gets a flu mist. Can we report 99211?

Ohio Subscriber

Answer: You can code a nurse visit 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 ...) in addition to the vaccine administration (90473, Immunization administration by intranasal or oral route; one vaccine [single or combination vaccine/toxoid]) only if the nurse encounter is for a medically necessary reason and justifies a separate evaluation and management service. Do not use 99211 for the routine vital check the nurse customarily performs prior to giving the spray.

Example: A child has a cough (786.2) and fever (780.60, Fever, unspecified) and the nurse does an assessment and discusses the condition with the pediatrician. The physician agrees that the nurse can still go ahead and have the patient receive the immunization.

The nurse documents her assessment and findings. Both the nurse and supervising pediatrician sign the chart. You could use 99211 with 90473.

Tip: Look for a chief complaint when considering 99211 with an immunization administration. If the patient presents with a problem that's documented and supported by a separate ICD-9 code, a nurse visit might be appropriate.

Without a problem (or chief complaint), the nurse's role is part of the administration's inherent preprocedure work.