Ob-Gyn Coding Alert

Question: Our ob-gyn office does backup for a midwife practice. They referred a patient to us to receive the H1N1 vaccine. Patient arrived and had a lot of questions. My nurse answered all her questions and administered the vaccine. After the patient left, she called and spoke with our nurse numerous times (at least five times) about the vaccine. We charged a phone consult (which is the patient's responsibility to cover). Should we have billed 99211 with the vaccine charges?

Georgia Subscriber

Answer: No, you should not have billed 99211 (Office or other outpatient visit ...). The administration code (90470, H1N1 immunization administration [intramuscular] [intranasal] including counseling when performed]) includes patient counseling. Code 99211 requires a face-to-face encounter for the evaluation and management of a problem.

You can no longer use the telephone codes (99441-99443, Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment ...) for follow-up to a problem seen in the office within seven days of the visit. CPT guidelines state: " ... if the telephone call refers to an E/M service performed and reported by the physician within the previous seven days (either physician requested or unsolicited patient follow-up) or within the postoperative period of the previously completed procedure, then the service(s) are considered part of that previous E/M service or procedure."

-- The answers for Reader Questions provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.