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Primary Care Coding Alert

Reader Question:

Beware of Billing Office Visit With Vaccine

Published on Mon Aug 06, 2012

Question: Our physician tried to bill an office visit (99213) along with codes for a vaccine (90715) and its administration (90471). His only diagnosis is V06.1 (Need for prophylactic vaccination and inoculation against combinations of diseases; diphtheria-tetanus-pertussis combined [DTP] [DTaP]). I think we should only bill the vaccines, even if he wants to report the office visit with a modifier. What do you recommend? New Mexico Subscriber Answer: First, the correct administration code depends on the age of the patient and whether the physician performed counseling during the encounter. If he only administered the vaccines -- with no counseling -- or the patient was older than 18 years of age, report 90715 (Tetanus, diphtheria toxoids and acellular pertussis vaccine [Tdap], when administered to individuals 7 years or older, for intramuscular use) and 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]). If he did perform [...]
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