Medicare Compliance & Reimbursement
Note That Immunization by MA Doesn't Usually Qualify for E/M
Question: This is the first year we are considering providing FluMist without a physician visit. Our medical assistants (MAs) will be administering the shot after the patient fills out a questionnaire. The MAs do not qualify to bill 90460. Should we report 90471 or 90473 for the FluMist? Or should we opt for 99212?
Answer: Your best bet is to bill 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]).
You cannot report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components…) since the medical assistant cannot report that code and no physician saw the patient face-to-face during your visit. If your state law allows it and has communicated that to you in writing, 99211 is an option to report with 90473, since the MA did go over the questionnaire with the patient. Keep in mind that 99211 is bundled into any immunization administration without the ability to “unbundle” the service with a modifier. So, you are left with only reporting the vaccine administration and the supply of vaccine, 90660.
You should report V04.81 (Need for prophylactic vaccination and inoculation against influenza) as the diagnosis code.
Medicare Compliance & Reimbursement
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