Pulmonology Coding Alert

Question: In our office, a nurse practitioner (NP) saw a 65-year-old established patient for a pneumonia vaccination. Before administering the vaccine, she took a brief history, checked the patient’s vital signs and ruled out any contraindications for the vaccine. Can I report an E/M in addition to the vaccination codes?

New York Subscriber

Answer: No. From your description of the NP’s actions, she did not do much beyond providing the E/M service built into most CPT^® codes. For that reason, you should just report the vaccination codes.

On the claim, report the following:

• 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use) for the pneumonia vaccine
• 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for the pneumonia vaccine administration.

Note: For Medicare patients, and payers that observe Medicare rules, use G0009 (Administration of pneumococcal vaccine) for the administration rather than 90471.

Be sure to link Z23 (Encounter for immunization) to 90732 and 90471 (or G0009) to prove medical necessity for the service.

Explanation: All CPT^® codes have an inherent E/M service (a brief patient assessment required before undergoing any type of procedural service) built into them. The E/M the NP provides the patient during the vaccination must go beyond this inherent E/M in order to report a separate E/M code.

If you can identify a problem that the nurse practitioner assesses and separately treats (i.e., implements a plan of care), you might be able to report an E/M service along with the immunization codes. You will need to add modifier 25 to the E/M (e.g., 99213-25).