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?

South Carolina 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, 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.

• V03.82 (Streptococcus pneumoniae [pneumococcus]) linked 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 to report a separate E/M code.

If you can identify a problem that the nurse assesses and separately treats (at the direction of the physician), you might be able to report an E/M service along with the immunization codes.