Question: Oregon Subscriber Answer: You'll report an E/M for the FP's services and a code for the vaccination admin. On the claim, report the following: • 90470 (H1N1 immunization administration [intramuscular, intranasal], including counseling when performed) for the vaccine administration; • V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; influenza) appended to 90470 to show the medical reason for the H1N1 vaccine; • 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity ...) for the E/M service; • 623.8 (Noninflammatory disorders of vagina; other specified noninflammatory disorders of vagina) appended to 99213 to represent the patient's vaginal bleeding; • 285.1 (Other and unspecified anemias; acute posthemorrhagic anemia) appended to 99213 to represent the patient's anemia; and • modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99213 to show that the E/M and vaccination were separate services. (Note: You have a CPT code for the H1N1 vaccine: 90663 [Influenza virus vaccine, pandemic formulation]. Because the vaccine is currently free for physicians, you do not need to report this code on your claim form. You can, however, assist with vaccine safety tracking.)