Primary Care Coding Alert

Question: An 18-year-old female established patient reports to the FP complaining of weakness and fatigue; she rates her fatigue at 8 on a scale of 10, saying "I can barely get out of bed." After a level-three E/M that includes a rapid screen, the physician determines the patient does not have H1N1, but is suffering from anemia due to heavy, acute vaginal bleeding associated with fibroids. The patient requests an H1N1 vaccination, which the nurse provides. How should I code this encounter? Oregon Subscriber Answer: You'll report an E/M for the FP's services and a code for the vaccination admin. On the claim, report the following: • 90470 (H1N1 immunization administration [intramuscular, intranasal], including counseling when performed) for the vaccine administration; • V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; influenza) appended to 90470 to show the medical reason for the H1N1 vaccine; • 99213 (Office or [...]