Pulmonology Coding Alert

Question: A nurse practitioner (NP) sees a 65-year-old established patient for a pneumonia vaccination. Before administering the vaccine, she takes a brief history, checks the patient's vital signs, and rules out any contraindications for the vaccine. Can I report an E/M in addition to the vaccination codes?

Montana Subscriber

Answer: Probably not. 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, you should 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 when no physician fee schedule service on the same day) for the administration rather than 90471.

Be sure to link V03.82 (Need for prophylactic vaccination and inoculation against bacterial diseases; streptococcus pneumoniae [pneumococcus]) to 90732 and 90471 (or G0009) to support medical necessity for the service.

Reason: All procedural services 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 and demonstrate additional, medically necessary management in order to report a separate E/M code. If you can identify a problem that the NP assesses and separately treats, you might be able to report an E/M service along with the immunization codes.

The answers to the Reader Questions and You Be the Coder were provided and reviewed by Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta;

and Carol Pohlig, BSN, RN, CPC, ASC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.