Wiki Flu Vaccine a Professional Service?

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dballard2004

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I have a very interesting scenario that I would like guidance on please.

Per CPT Assistant, a new patient is one who has not received any professional services for the physician (provider), or another physician (provider) of the same specialty who belongs to the same group practice, within the past three years. An established patient is one who has received professional services for the physician (provider), or another physician (provider) of the same specialty who belongs to the same group practice, within the past three years. They go on to say that a new vs. an established patient does not necessarily mean a face-to-face encounter, but professional services. They say that if the patient has received a professional medical service from the provider, other than for administrative reasons then the patient would not be considered a new patient, but rather an established patient.

Now for my question, if a patient comes in for a flu vacicne only and is seen by an NP for the administration of the flu vaccine, then is the flu vaccine considered to be a professional service that would "establish" the patient?
 
Thanks. What if the patient was new, but only saw the nurse (RN) for the vaccine? Would this establish care as well or is the deifferance the provider (RN vs. NP)?
 
You cannot have a new patient see only the nurse and bill for that service. The nurse services are always billed under the physician as incident to services and you cannot do that for new patients.
 
Ok. So let's say that a new patient came into our clinic for a flu vacicne only that was been done as part of a flu clinic and was being roster billed. No NP or MD present just RNs because it is a flu clinic only. We give the flu vaccine and then a couple of weeks later the patient returns for a sick visit with the MD, then is this patient new or established?

I'm thinking because it was roster billed by the RN only and not under the NP or MD, that this would make them a new patient. If it was billed under the NP or MD's NPI and they supervised the services, then this would establish the patient. Am I on the right track here?
 
Remember the following regarding the influenza vaccine:

•Medicare allows one influenza (flu) vaccination per year;
•Medicare does not require for coverage purposes that a doctor of medicine or osteopathy order the influenza vaccine and its administration; and
•The beneficiary may receive the influenza vaccine upon request without a physician's order and without physician supervision.

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6121.pdf

The simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass pneumococcal and influenza virus vaccination programs offered by PHCs and other individuals and entities that give the vaccine to a group of beneficiaries, e.g. at PHCs, shopping malls, grocery stores, senior citizen homes, and health fairs.

http://www.cms.hhs.gov/manuals/downloads/clm104c18.pdf

10.3


Dawson,

If the patient received the flu shot and the claim was submitted by roster billing, the return, face to face, visit with the physician would be considered new...assuming there was no previous face to face with that physician or same specialty physicians within that group (within the last 3 years).
 
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