Charging Flu Shot And Nurse Visit

[DHARRIS]

It's flu season again and the annual discussion of whether to charge for a nurse visit. I need documentation on this issue. Can we charge a nurse visit for each patient when they come in for a flu shot? More importantly is it payable? Does anyone else charge this way?

 

[kevbshields]

CMS has made this issue explicitely clear. I do not have a link to provide you, but trust the statement has been made:

When patients present for Flu shots (only), then the charges should reflect those services (administration/vaccine code/HCPCs).

To my knowledge, that has not changed. Look at it this way, the nurse is doing nothing in addition to administering that vaccine. With that being the case, it's hard to argue a 99211 as appropriate.

Of course, as with every aspect of coding, some payers may have requirements unique to their members. Let that--upon written support--guide your code selection also.

I'm sure that searching the CMS website will yield a specific directive.

Good luck to you.

 

[Rhonda Buckholtz CPC]

Try this link: http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf