Wiki Vaccine visit

[nc_coder]

We have a new patient coming in to see the provider. There is no real diagnosis for this visit. She just needs vaccines updated before going to college. It is not time for her physical and there is no other diagnostic need for the visit. The patient has been told upfront that insurance usually does not pay for this type of visit. I am looking for opinions on how this should be coded.

 

[mitchellde]

You use the V code(s) for the prophylactic administrations and the CPT codes for the administration. Some insurances will pay for these, Mine paid for all of my childrens vaccines for college.

 

[nc_coder]

Did the insurance pay for an E/M visit too or just the admin codes?

I have billed an E/M with the prophylactic codes and it has been paid before, but is this the right way to do it?

 

[mitchellde]

If the only issue for the encounter is the vaccine then there is no E&M there is only the substance and the administration.

 

[nc_coder]

No E/M even if this is a new patient?

 

[mitchellde]

Not if the vaccines were planned. And not if there is no exam other than what is needed for the vaccine.

 

[nc_coder]

I am still stuck on the vaccine admin. I understand only using the substance and admin if it is a child and 90460 (with counseling) is used for the admin code. But, if it is an adult and 90471 (without physician counseling) is used, should I not bill an E/M if the physician provides counseling?