99211 nurse visit and 90471

[sgormsen]

Is it appropriate to bill a 99211 when a pt comes in for an injection ONLY?
ex:99211
90649
90471

Thank you,
Susan

[lavanyamohan]

Hi,
Can't bill nurse only visits for vaccinations, as these services are preventive medicine services rendered at the time of physician encounter.
Blood pressure check, suture removal, Vitamin B12 injections are some of the examples of nurse only visits.
Don't confuse-90471 is vaccine administration code- vaccination code follows;
90772- is injection administration code; J code follows
Both these administration services are rendered by doctors and only billable for them.

[zaidaaquino]

Per CPT book, you would be correct in billing 90471 (immunization administration code) with 90649 (vaccine product). Under the Immunization Administration for Vaccines/Toxoids section, it provides further guidelines. For example, it says that for the immunization admin of any vaccine that is not accompanied by face-to-face physician counseling to the patient/family, report codes 90471-90474. If a significant separately identifiable E&M service is performed, the appropriate E&M code should be reported.

Zaida, CPC

[Lisa Bledsoe]

Originally Posted by lavanyamohan

Hi,
Can't bill nurse only visits for vaccinations, as these services are preventive medicine services rendered at the time of physician encounter.
Blood pressure check, suture removal, Vitamin B12 injections are some of the examples of nurse only visits.
Don't confuse-90471 is vaccine administration code- vaccination code follows;
90772- is injection administration code; J code follows
Both these administration services are rendered by doctors and only billable for them.

I agree that 99211 is not billable with injection or immunization administrations...But adminstrations are performed by ancillary staff and billed as incident to the doctor. The doctor does not have to do the administration.

[sgormsen]

Thank you for your input.
Now the question that is asked is: If the patient's vitals are taken prior to the admins of an injection or vaccine is it appropriate to bill a 99211?

thank you,
Susan

[Kumaran]

Hi,

You can charge 99211 if the provided documentation done.

For example if patient was seen for BP check and their is a dx code to support 99211 other than vaccine then you would bill a 99211 with tagged dx

Thanks
Vallikumaran B.P.T,, CPC

[abenson]

make sure to add a 25 modifier to 99211 if the exam is unrelated.

[bhaskins1]

I'm in Pediatrics and we come across this issue frequently.. per the American Academy of Pediatrics book "Coding for Pediatrics 2008" the administration of the vaccine includes:
Administrative staff services, such as making the appt, preparing the chart, billing for the service, filing the chart.
Clinical staff services, such as greeting the pt, taking routine vital signs, obtaining a vaccine history on past reactions and contraindications, presenting a Vaccine Information Statement (VIS) and answering routine vaccine questions, preparing and administering the vaccine with chart documentation and observing for any immediate reaction.

With that said, in order to code an E&M the service provided must exceed those services. When the nurse documents a significant and separate complaint or problem the additional reporting of 99211 is justified.

Even though my resource is a Pediatrics resource, I would think it would apply to all ages. In addition the modifier 25 should not be necessary because if the complaint/problem is significant and separate you should have another ICD-9 in addition to the V codes for the vaccine. We do get paid by commercial insurance without the modifier (side note: I audit these before they go out to be sure the nurse documented correctly to justify the 99211 because as always, if it's not documented, it was not done!)

[moricecrys]

Originally Posted by lavanyamohan

Hi,
Can't bill nurse only visits for vaccinations, as these services are preventive medicine services rendered at the time of physician encounter.
Blood pressure check, suture removal, Vitamin B12 injections are some of the examples of nurse only visits.
Don't confuse-90471 is vaccine administration code- vaccination code follows;
90772- is injection administration code; J code follows
Both these administration services are rendered by doctors and only billable for them.

Why would we bill the nurse visit with the B-12? We apply the administration code? Very confused, can you go into more details please? Thanks

[mitchellde]

There is more than a ton of information on this written. In 2002 Kathleen Mueller who was the compliance office for CMS wrote a special report for Decision Health on the subject of the use of the 99211. In this report she stated you could not use a 99211 for a visit when the purpose was to administer an injection or draw blood. Even if vital signs were taken as a part of the service. The idea being that this was a planned encounter for the purpose of administering this injection and just like the planned return for a joint injection, you cannot charge an E&M be it 99211 or otherwise. I would be really careful about using a 99211 with a 25 modifier for a blood pressure check with an injection, especially if it were established office procedure to perform a BP check for every patient receiving an injection. This is really shakey ground so think about it first.