Wiki Can we give injections/vaccines to patient when the provider is virtual

[Troykall1]

We are a HIV/STI clinic in Colorado and we have providers who are virtual to our clinic once a week. The patients still come to the clinic but the provider is virtual on screen in the exam room. If the provider orders vaccines we have been getting denials on the E/M and paid for the vaccine. The denial is place of service miss match. We have been using POS 2. We only have MA in office at this time. Are injections even allowed in this situation? If so, how do I code this. Currently we have limited this day to just PrEP for HIV with labs only. If they need a vaccine we have them schedule a PCP visit when a provider is in office.
I have a feeling we should not be giving any injections or preforming any provider guided tests if they are not physically in office. Our provider feels that there has to be a way.
thanks for all your help.

 

[ambernic]

We are a HIV/STI clinic in Colorado and we have providers who are virtual to our clinic once a week. The patients still come to the clinic but the provider is virtual on screen in the exam room. If the provider orders vaccines we have been getting denials on the E/M and paid for the vaccine. The denial is place of service miss match. We have been using POS 2. We only have MA in office at this time. Are injections even allowed in this situation? If so, how do I code this. Currently we have limited this day to just PrEP for HIV with labs only. If they need a vaccine we have them schedule a PCP visit when a provider is in office.
I have a feeling we should not be giving any injections or preforming any provider guided tests if they are not physically in office. Our provider feels that there has to be a way.
thanks for all your help.

I'm wondering if you should be billing with POS 11. Per CPT guidelines, administration can be done by physician or qualified health care professional. I believe it is okay to perform the injection when the provider is not in the office as long as the administration of the vaccine is done by a qualified health care professional (ie, MA).

 

[cnjacobs15]

We have a provider that is completely telehealth and her patients come into the office.. When the provider orders vaccines during the telehealth appointment for the nurse to administer we have the front desk schedule a separate "nurse visit" encounter. They then bill for the vaccines/any other services off of that encounter to separate it from the provider visit so it will be billed with POS 11.. If we do not do that then the entire claim Office visit vaccines injections testing whatever is done in office go out with POS 02 which we actually get paid on the E&M but denials for anything else done due to for the invalid service for the POS.

 

[Troykall1]

We have a provider that is completely telehealth and her patients come into the office.. When the provider orders vaccines during the telehealth appointment for the nurse to administer we have the front desk schedule a separate "nurse visit" encounter. They then bill for the vaccines/any other services off of that encounter to separate it from the provider visit so it will be billed with POS 11.. If we do not do that then the entire claim Office visit vaccines injections testing whatever is done in office go out with POS 02 which we actually get paid on the E&M but denials for anything else done due to for the invalid service for the POS.

Thank you so much! I was thinking we were the only ones out here doing this. We currently have a policy that we only see PrEP for HIV, walk in STI testing, and sick visits on the virtual days, no injections. We would love to do vaccines at the same time as a lot of our patient population is struggling with housing so you have to do what we can when they are here. We currently only have the one NP who floats in regions, that is why they are virtual on certain days. So they would be the provider on both claims. I am not sure that would work, would it. Can I submit the E/M with POS 2 and a modifier 25 and then the nurses visit as POS 11, both under the same NP? Do you charge the 90211 with the vaccines or just the injection administration code? Thank you for your help. really, we have been struggling with this.

 

[Troykall1]

I'm wondering if you should be billing with POS 11. Per CPT guidelines, administration can be done by physician or qualified health care professional. I believe it is okay to perform the injection when the provider is not in the office as long as the administration of the vaccine is done by a qualified health care professional (ie, MA).

Thank you for responding, we are really struggling with this. We did think about just billing them as POS 11 but I reached out to Colorado Medicaid and they said that if the provider is off site then we would have to bill the E/M as POS 2. So we billed that way and they denied the E/M and paid the vaccines! I know, I would have thought it would be the other way. The comment below from cnjacobs15 sounds promising. I am waiting to hear more from them.

 

[debradwright]

I had a similar situation when I coded for a hospital in Alaska, the providers would be on site and the patients would be at home. The provider would order a UA/lab/vaccine/etc for the patient to be done same day. We had to manually split the billing to bill the telehealth visit on one claim with the appropriate telehealth POS, and then bill the other services for when the patient came in the same day with POS 11 on a SEPARATE claim.

 

[ecurtis]

Injections and vaccines fall under incident to. If there isn't a provider in the building during the visit to bill under, you don't meet incident to guidelines and can't bill.

 

[lbortzfield]

We are a HIV/STI clinic in Colorado and we have providers who are virtual to our clinic once a week. The patients still come to the clinic but the provider is virtual on screen in the exam room. If the provider orders vaccines we have been getting denials on the E/M and paid for the vaccine. The denial is place of service miss match. We have been using POS 2. We only have MA in office at this time. Are injections even allowed in this situation? If so, how do I code this. Currently we have limited this day to just PrEP for HIV with labs only. If they need a vaccine we have them schedule a PCP visit when a provider is in office.
I have a feeling we should not be giving any injections or preforming any provider guided tests if they are not physically in office. Our provider feels that there has to be a way.
thanks for all your help.

We split bill the claim, the E/M with POS 02 and the vaccine/injection/testing with POS 11 on different claim, with nurse that performed as Actual provider and ordering physician as billing provider.

 

[cnjacobs15]

Thank you so much! I was thinking we were the only ones out here doing this. We currently have a policy that we only see PrEP for HIV, walk in STI testing, and sick visits on the virtual days, no injections. We would love to do vaccines at the same time as a lot of our patient population is struggling with housing so you have to do what we can when they are here. We currently only have the one NP who floats in regions, that is why they are virtual on certain days. So they would be the provider on both claims. I am not sure that would work, would it. Can I submit the E/M with POS 2 and a modifier 25 and then the nurses visit as POS 11, both under the same NP? Do you charge the 90211 with the vaccines or just the injection administration code? Thank you for your help. really, we have been struggling with this.

I apologize for the delay! we do not bill 99211. We bill injection/admin codes only. We have a NCNUR "charge" that comes over but it has a$0 charge and does not go out on the claim and i believe you should be able to bill under the same NP.. the key to this is the separate claims one POS 2 one POS 11.. IF your EHR/billing system can separate them with the same NP i don't see why not..