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Pulmonology Coding Alert

NCCI Update:

Version 12.0 Says You Can't Report Nurse Visits With Immunizations

Published on Tue Feb 14, 2006

The good news is this edit won't have dire effects on your pulmonology practice

If your pulmonology office has a nurse who administers vaccinations, you'll want to take note of a new NCCI bundle. When your nurse administers an immunization, you won't be able to report both the vaccine administration and the E/M services.

NCCI 12.0 bundles the codes for immunization administration for vaccines and toxoids (90465-90474) 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).

Note: You shouldn't have to worry about these edits causing coding problems for your pulmonology practice,
however. Medicare doesn't recognize codes 90465-90474 for their limited immunization coverage (flu, pneumo, Hepatitis B), says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. Medicare only covers other immunizations if the beneficiary received it in response to illness/injury (e.g., a tetanus shot, 90703).

Typically, the patient would be experiencing a new problem, which would warrant a visit by the physician or other advanced practitioner, and not the nurse.

For example, if the patient has an injury, and your physician administers a tetanus shot, you should report 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]), 90703 (Tetanus toxoid absorbed, for intramuscular use), and the code representing the most appropriate E/M service.

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