Wiki Coding 99211 w/Immunizations

[Lisa K Williams]

I work for a FQHC which gives alot of immuznizations for the community that we are surrounded by. I get alot of questions about coding an E&M(99211) visit with the immuniztion administration codes 90460 and 90471. There were no additional services provided except the immunizations. Per the coding books I have, the CPT Professional edition states that an E&M can be used if a seperatly identifible service is performed.

I also use the code book by PMIC, CPT Plus and per their guidelines it states that when an immunization is the only service provded an E&M service code 99211 may be reported in addition to the immunization. So with that being said I'm a little confused. Why would we bill for an minimal service code of 99211, when the administration codes of 90460 and 90471 cover the services of the administration of the immunization. What would be the reason for billing an 99211??

Can someone please offer me some guidance on this matter
Thanks so much
Lisa Williams, CPC

 

[mitchellde]

You do not bill a 99211 if an immunization is the only service offered. If there is a evaluation for a different issue on the same day as an immunization then the appropriate visit level may be billed with a 25 modifier and if the documentation supports only a 99211 then it may be billed. I am not certain why the PMIC version would state the instruction in that way but it is suppose to mean the same thing as the instruction in the AMA version.