Wiki ICD 10 question

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gcohen

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When a new patient requires an office visit for just an immunization, we use the Z code for the diagnosis, correct? No problems documented.
 
Yes just the Z23 however of this is an encounter to receive an immunization only then you would not use an office visit level . You will use the appropriate immunization administration code(s) along with the code for the specific immunization. You would not have a separately identifiable office visit to bill, even if it is a new patient.
 
gcohen said:
The provider did an exam, PFSH, HPI, Vitals as we will not give an immunization to a child we have never seen before.
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Understood, however the reason for the encounter is to receive the injection. the evaluation of the patient is included with the injection administration, since there is nothing that is significant or separately identifiable to base a separate exam upon.
 
Clarification

mitchellde said:
Understood, however the reason for the encounter is to receive the injection. the evaluation of the patient is included with the injection administration, since there is nothing that is significant or separately identifiable to base a separate exam upon.
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Hi Michelle,

Thanks for the response. I'm curious about the documentation for this as the practice I currently work for repeatedly bills immunizations as a level 1 'nurse visit'. I usually write the balance off, but have been told by my supervisor that my writing it off is against the practice policy. I'd like to be able to back up the write off. Does this constitute abuse? Or is it too vague a rule to really have a consequence for?
 
Clarification

Gucare said:
Hi Michelle,

Thanks for the response. I'm curious about the documentation for this as the practice I currently work for repeatedly bills immunizations as a level 1 'nurse visit'. I usually write the balance off, but have been told by my supervisor that my writing it off is against the practice policy. I'd like to be able to back up the write off. Does this constitute abuse? Or is it too vague a rule to really have a consequence for?
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Is the vaccine and administration being billed as well? The 99211 should not be billed in addition to those for the encounter just for immunizations.
 
Gucare said:
I'm curious about the documentation for this as the practice I currently work for repeatedly bills immunizations as a level 1 'nurse visit'. I usually write the balance off, but have been told by my supervisor that my writing it off is against the practice policy. I'd like to be able to back up the write off. Does this constitute abuse? Or is it too vague a rule to really have a consequence for?
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It is not a vague rule. Documentation addressing this can be found in the NCCI Policy Manual, Chapter XI, under section B, Therapeutic or Diagnostic Infusions/Injections and Immunizations: "Similar to drug and chemotherapy administration CPT codes, CPT code 99211 (evaluation and management service, office or other outpatient visit, established patient, level I) is not separately reportable with vaccine administration HCPCS/CPT codes 90460-90474, G0008-G0010." As the manual explains, drug and vaccine administration codes "have been valued to include the work and practice expenses of CPT code 99211". Since most payers follow NCCI guidelines and use RVU-based reimbursement, it would be inappropriate, and could considered unbundling, to bill 99211 for office services on the same day as an immunization administration.
 
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