Internal Medicine Coding Alert

Published on Tue Nov 28, 2006 PDF

Question: A new patient presented to our office for the sole reason of getting a flu shot. The physician met the patient and took some history, but per the documentation there really is not a problem or diagnosis that I can tag to a visit. Can we bill a flu shot only to a new patient without having first billed out an office level?

Maine Subscriber

Answer: If the patient visited your practice just for the flu shot and not for any E/M services, you can just bill the shot and not a new patient E/M visit (99201-99205). See our article "5 Steps Help You Pinpoint the Right Flu Shot Code" in this issue to determine how to choose the right code for the immunization and the administration.

Contrary to popular belief, you do not have to bill a new patient visit for a patient before you perform services for him. But keep in mind that once you give the patient the flu shot, the patient is an established patient. Therefore, if your internist gives the patient the shot and then the patient returns for an E/M visit within the next three years, you should bill an established patient office visit (99211-99215) and not a new patient visit.

Both the AMA and CMS define a new patient as one who has not received any professional face-to-face services from the physician or another physician with the same specialty in the same group within the previous three years.