Billing 99211 with G0008?


Local Chapter Officer
Frederick, MD
Best answers
Medicare states that if you bill a administration code (90772,G0008,etc), it means the patient was seen by a physician. So, can you bill 99211 if the patient just came in for a flu shot? Mcr always bundles it to the E&M.
Medicare will pay for the G0008 and the flu shot 90658. Do not bill the nurse visit because it will be considered inclusive and you will write off the money.
Drug Administration Services and E/M Visits Billed on Same Day of Service Carriers must advise physicians that CPT code 99211 cannot be paid if it is billed with a drug administration service such as a chemotherapy or nonchemotherapy drug infusion code (effective January 1, 2004). This drug administration policy was expanded in the Physician Fee Schedule Final Rule, November 15, 2004, to also include a therapeutic or diagnostic injection code (effective January 1, 2005). Therefore, when a medically necessary, significant and separately identifiable E/M service (which meets a higher complexity level than CPT code 99211) is performed, in addition to one of these drug administration services, the appropriate E/M CPT code should be reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.