Internal Medicine Coding Alert

Published on Mon Apr 19, 2004 PDF

Question: A new patient came to the office just for a flu shot. Because the patient is new, he has to fill out paperwork. Should we tell him he has to see a doctor before we'll provide the shot? Or should I examine the patient before the shot?

Tennessee Subscriber

Answer: Unless the patient has a medically necessary reason to see the physician prior to the flu shot, the physician should not bill for the visit. That's because your payer will likely deny the claim as not medically necessary. And, if you require the patient to see the doctor prior to the shot just to receive additional revenue, you could be in trouble if the payer audits your practice.
 
During flu season, many practices establish clinics in which a nurse or other staff members provide flu shots and the patient never visits a doctor. To get reimbursed for the administrative costs of providing flu shots, you should report 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) to private payers. For Medicare carriers, use G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day).