Pulmonology Coding Alert

Question: When an established non-Medicare patient reports to the office for a flu shot, can I report a nurse visit along with the injection?


West Virginia Subscriber
 

Answer: It depends. If the patient scheduled an appointment for a flu vaccination, and the nurse does not provide any additional E/M service, you should only report the vaccine supply and an administration code.

When selecting a supply code, choose from:

• 90655 -- Influenza virus vaccine, split virus, preservative-free, for children 6-35 months of age, for  intramuscular use

• 90656 -- Influenza virus vaccine, split virus, preservative-free, for use in individuals 3 years and above, for intramuscular use

• 90657 -- Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use

• 90658 -- Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use.
 
When selecting an administration code, choose from:

• 90465 (Immunization administration under 8 years of age [includes percutaneous, intradermal, subcutaneous, or intramuscular injections] when the physician counsels the patient/family; first injection [single or combination vaccine/toxoid], per day) for patients younger than 8 years of age, and

• 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for beneficiaries 8 and older. 

Exception: If the nurse performs E/M beyond the work required for a flu shot -- such as medication counseling -- you could:

• report 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician) in addition to the flu shot and administration.

• append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99211 to show that the nurse performed a flu shot and a separate E/M.

Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.