Pulmonology Coding Alert

Although reporting the flu vaccine administration and drug used is straightforward, billing a patient evaluation (99211) during the same visit is more complicated. With the approach of fall, many patients are requesting flu and pneumonia shots as an insurance policy for the winter season. Other patients come into their pulmonary physician's office for an unrelated reason, and a nurse or doctor suggests that a flu shot would be a good idea. This apparently small difference affects how you code for the vaccination. Code 99211 is for an 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, and the pulmonologist spends about five minutes performing or supervising these services. Coding Vaccine Administration For all patients, you should report the administration of the injection. For Medicare and carriers that follow Medicare guidelines, you should use G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day) or G0009 (Administration of pneumococcal vaccine when no physician fee schedule service on the same day). If your carrier does not follow Medicare, use 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) for the flu or pneumonia administration. You should use +90472 (& each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) only if the flu and pneumonia vaccines are provided on the same date of service. Otherwise, only 90471 would be reported for the single immunization. Remember, CPT identifies 90472 as an add-on code and, as such, it cannot be billed without reporting 90471 first. You would not need to append a modifier (e.g., -51, Multiple procedures) to 90472 because this procedure code does not stand alone and is an additional portion of another procedure. Also, G0008 and G0009 may be reported in addition to the immunization code (e.g., 90657, Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular or jet injection use) and the E/M service despite the code's descriptor stating, "when no physician fee schedule service on the same day."

Conversely, 90471 and 90472 cannot be reported or reimbursed if performed on the same day as an E/M service. The codes have a "T" status in the Federal Register, which means these services are not payable when reported on the same day as another service that is payable under the Physician Fee Schedule. Therefore, you could report only the immunization code and the E/M service. You should also bill one of these codes for the influenza vaccine supply: 90657; 90658 (Influenza virus vaccine, split virus, 3 years and above dosage, for [...]