Wiki e/m diagnosis V04.81

[laura_clffrd@yahoo.com]

Patients are coming to the office cc is flu shot. They do the family history, social history, check weight,temp,pulse, height. Physical exam findings general, skin, eye,cv,resp, all wln...impression is flu vaccine.

I need to show documentation that if they are coming in for a flu vaccination we can only charge the 90471, 90658...What if they have not been there in a year and our doctors require a visit prior to vaccination? Can they bill the 99212,99213?

Thanks

 

[LLovett]

Where is the medical necessity for the visit? They can get a flu shot at Walgreens, no appointment or exam needed.

If the patient wasnt' coming for a flu shot, would they be seen at all? If the answer is yes, then you could probably support an E/M. If the answer is no, which it most likely is since your only dx is need for flu shot, then there is no medical necessity for the visit and it would be inappropriate to submit any level E/M with a 25 modifier.

As far as documentation you can show the definition of modifier 25 and there is a lot of stuff out there about medical necessity.

Hope this helps,

Laura, CPC, CPMA, CEMC