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Pulmonology Coding Alert

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Reporting 99211 With Flu Shots

Published on Sat Jan 01, 2005

Question: Can I report a nurse visit (99211) with a flu shot?

 
Virginia Subscriber


Answer: If the patient comes to your office for his annual flu vaccination, and this is the only service that he receives during the visit, you may not report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) in addition to the vaccination.
 
You should only report the vaccine and administration codes. The report vaccine codes include:

  •  90655 - Influenza virus vaccine, split virus, preservative-free, for children 6-35 months of age, for intramuscular use

  •  90656 - Influenza virus vaccine, split virus, preservative-free, for use in individuals 3 years of age and above, for intramuscular use

  •  90657 - Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use

  •  90658 - Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use.

    The administration codes include:

  •  G0008 - Administration of influenza virus vaccine when no physician fee schedule service on the same day for Medicare beneficiaries

  •  90465 - Immunization administration under 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; first injection (single or combination vaccine/toxoid), per day for patients < 8 years old

  •  90471 - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid) for non-Medicare beneficiaries > 8 years old. 

    It is only appropriate to report a "nurse visit" with the vaccination if the nurse performed a separate and medically necessary service (that is, medication counseling if the patient has been having difficulty in complying with the regime due to a lack of understanding about the correct dosages and times).
     
    You should append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to code 99211 to indicate that the nurse performed a service separate from the vaccination.

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