Wiki E/M 99211 During nurse visit

[gsccardmore16]

When we do a wellchild visit but the child return the following week for their immunizations (nurse visit only) can I code a 99211 for our nurses visit as well as the other CPTs that show the immunizations were given? Same question for a patient who just comes in for a nurse visit and gets their injection, Can I bill a 99211?

 

[christinaoliver]

I would say if the injections are planned , then no , you would not bill a 99211. If there is documentation that the visit went above and beyond the injections then yes.

 

[CodingKing]

The work is accounted for in the vaccine admin code so there should not be an E&M for the vaccines.

 

[thomas7331]

I agree, the nurse visit 99211 code is not separately reportable. I'd add that even if you do have documentation of a separate service and bill with a modifier 25, most payers will still deny this - on the NCCI tables, 99211 paired with a vaccine or drug administration code is assigned a '0' indicator for 'no modifier allowed', so any payer that follows NCCI will consider this a bundled service regardless of modifier use. Per the NCCI manual: "CPT code 99211 (evaluation and management service, office or other outpatient visit, established patient, level I) is not separately reportable with vaccine administration HCPCS/CPT codes 90460-90474, G0008-G0010. Other evaluation and management (E&M) CPT codes are separately reportable with a vaccine administration code if the E&M service is significant and separately identifiable, in which case the E&M CPT code may be reported with modifier 25."