Wiki Coding 99211 with influenza vaccine

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E. Knowlton

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Can you tell me if other practices code 99211 with a visit for the influenza vaccine in addition to 90471 and 90656 with diagnosis of V04.81? When reviewing the record, the nurse is noting only that she performed the injection and lists the product used.
Thanks
 
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When a patient comes in for the purpose of an injection, vaccine or therapeutic, the administration code is what you use for the nurses time to give the injection along with the code for drug/serum. You do not use a 99211 as there is no significant evaluation taking place. You have only what is needed for the vaccine and that is covered with the 90471. EVEN if vital signs are taken you do not charge a 99211.
 
E. Knowlton said:
Can you tell me if other practices code 99211 with a visit for the influenza vaccine in addition to 90471 and 90656 with diagnosis of V04.81? When reviewing the record, the nurse is noting only that she performed the injection and lists the product used.
Thanks
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I agree. The 90471 covers the nurse visit. I would only use 99211 if the nurse is doing a port flush, ear wash or something of that nature.
 
What are the guidelines for a physician "supervising" the admin of immunization, vaccine, or hepb, b12 injections with an office visit? I have read from the apc site that if you bill medicare for the admin then you must bill commercial and/or hmo/ppo. Any thoughts or resources would be appreciated.
 
a physician supervision is a given and does not change the codes. It is still not a 99211 it is the drug plus the appropriate drug administration code.
 
HI Debra, I totally agree with your statement. However, my compliance dept wants the "documentation" such as CPT Asst. I could only find the article of April 2005, voulme 15, Issue 4, pages 1-5.
Do you know of a more recent CMS guidelines for this scenario?

Thanks, Terrie Hagen.
 
My patient had a brief exam with provider (Nurse Practitioner) before receiving the HPV vaccine from an RN, the only reason for the visit. HPI and exam are documented by the provider, as well as discussion of risks, etc. Provider coded 99212 in addition to admin & vaccine. Is that appropriate? Or should we be billing for the admin & vaccine only?

Thanks for your input. :)
 
No, it should be the vaccine and administration codes only.

Look, the way the insurance calculates the payments for all procedures, they include any routine pre and post procedure evaluation that would be necessary. If the patient came in for that procedure, and that's all that was done, then that's all that should be billed. Only if there is a significant, separately identifiable evaluation and management service on the same day should you bill for the additional service.

I know that there are insurances who are auditing practices who routinely bill 99211 with vaccine administration codes. It's a red flag for them.
 
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