Billing 99211 with G0008?

[gmsalw]

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.

 

[KristieStokesCPC]

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.

 

[RebeccaWoodward*]

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.

http://www.cms.hhs.gov/manuals/Downloads/clm104c12.pdf

 

[gmsalw]

Thank you so much for the info.