Pediatric Coding Alert

Following the Correct Coding Initiative (CCI) edits across the board might save you time, but doing so will unnecessarily cut your 99211 with 9047x pay. As a pediatric practice, you do not bill to Medicare.

Therefore, you can report 99211 (Office or other outpatient visit ... Typically, 5 minutes are spent performing or supervising these services) with 9047x (Immunization Administration for Vaccines/Toxoids) provided the insurer has not implemented CCI's bundle.

Best practice: Know your payers' policy on nurse visits with vaccine administration, encourages the American Academy of Pediatrics (AAP). While private payers often follow CMS' lead in such coding guidance, "some private payers and state Medicaid agencies do not use Medicare RBRVS or the NCCI edits and have their own reporting guidelines and payment policies for nurse visits," according to the AAP's position paper on 99211 with vaccine administration (www.cispimmunize.org/pro/pdf/AAPPositionPaper99211.pdf).