Doctors Giving Shots


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Hi everyone,

I am having a problem getting paid on our visits that are shots only. Since our docs are the only ones that give shots and they do a quickie exam before giving them to make sure the child is healthy enough I bill a 99212 along with whatever immunization it is. I don't use the admin code because I was taught that you can only bill one or the other (either the 99212 or the admin) but not both.

Two things are happening. Either they deny the 99212 totally and only pay the shot or they kick the 99212 over to the pt and consider it a well visit since a v code is used and there is no sick dx. But it's not a well visit either.

What am I doing wrong here?

Thanks in advance and I look forward to getting to know everyone.

You have to use an admin code for each immun that you do.....To use 99212 , vacc, and admin code IS THE CORRECT WAY TO BILL....

DX's -- (example) V05.3,V05.9
CPT's -- (example) 99212(1,2), 90633(1), 90471(2)
(the dx code it is related to)

Yes, sometime it is denied (5%). But if so, review the medical records for that pt and see if patient was seen for any other problems on that day; resubmit clm w/add'l primary dx code