Answer: Whether you can report a flu shot code with an E/M code depends on the circumstances of the visit, which explains why your denial record may not be entirely consistent.
Do not bill for flu shots and E/M codes for a patient who comes in for the flu shot only. Many coders and billers incorrectly pair flu shot codes 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. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services).
However, you can report an E/M code with a flu shot code if the patient comes in for a physical exam or problem visit and happens to receive a flu shot during the encounter. For this visit, you would report the appropriate influenza vaccine code (90657-90660), the administration code, and the appropriate E/M code. You could append the E/M code with -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to show payers that the E/M was a separate service from the flu shot. Check with your payers about the use of -25 in that situation.
The same report fits for the visit when the patient comes in for the flu shot and the physician discovers a problem and performs an exam.
For new patients requesting a flu shot, the physician may perform a physical exam as well, and you may be tempted to report both services. However, some payers will consider the exam incidental, so use the flu shot codes and let patients know that they may have to pay for the exam portion of the visit.
Remember that your reports with influenza vaccine codes, 90657-90660, need administration codes 90471-90474 as well. If you're billing for Medicare patients, use G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day) instead as an administration code. $ $ $ |
