Wiki E/M and flu shots

[TCarrasco]

Hi All,

I am needing clarification for my providers on when and when not to use and e/m code when patient presents for a flu shot.

For example: a patient comes in for a flu shot and no other services were provided.....is it possible for the provider to bill an e/m code for immunization review/counseling as the provider did review and document that he/she did review the patients immunization records?? The patients are being seen by the provider and not a nurse.

Would an e/m code be appropriate? Would counseling codes be more appropriate? or neither of the above??

Example 2: If a patient presents for a flu shot but at the same time is having symptoms of a cold. The patient is then examined by the provider for the cold and given the flu shot. Is it appropriate to bill the office visit (e/m ) code for this because the patient was also seen for the cold?
My guess in this example is yes, but my providers would like clarification on this issue, and especially for the first example, we have been going round and round about it....


any help on this will be greatly appreciated!!

 

[RebeccaWoodward*]

Below is CMS' guidance on this issue-

If a physician sees a beneficiary for the sole purpose of administering the influenza virus vaccine, the pneumococcal vaccine, and/or the hepatitis B vaccine, they may not routinely bill for an office visit. However, if the beneficiary actually receives other services constituting an “office visit” level of service, the physician may bill for a visit in addition to the vaccines and their administration, and Medicare will pay for the visit in addition to the vaccines and their administration if it is reasonable and medically necessary.

http://www.cms.gov/manuals/downloads/clm104c18.pdf

Page 12

 

[TCarrasco]

Thank you for your guidance!! I will print this up for my providers! :0)