Flu shots

[BJR1120]

I work in primary care and we are finding that some of our adult patients only want half of a flu shot. Normal dose right now is either 0.5 mL for quadrivalent or 0.7 mL for high dose. We use pre-filled syringes so using CPT 90685 or 90687 wouldn't work. Does anyone have any suggestions on how to bill for this or if there is a modifier we would use?
Thanks!

 

[thomas7331]

I would have thought that giving less that the recommended dose would not be considered standard of care and providers would not offer to do this. Are the providers really agreeing to this request from the patients?

 

[csperoni]

I would have thought that giving less that the recommended dose would not be considered standard of care and providers would not offer to do this. Are the providers really agreeing to this request from the patients?

I was thinking the same EXACT thing. I didn't go to pre-med, med school, internship, residency or have clinical experience. So, I usually take my doctor's medical advice over my 30 second google search, or what my neighbor the plumber recommends.
I'm also kind of surprised that people want a half dose. If you think (incorrectly) the vaccine is harmful, or have an allergy, or believe it's ineffective, or aliens are trying to mind control us with vaccines, etc., why would you want any of a dose?
My apologies that none of this answers the question posed, but this is a more interesting discussion to me.

Maybe modifier -52? But especially with pre-filled syringes, you are incurring the same cost (and same work) as a full dose.

 

[SharonCollachi]

I was going to suggest the modifier for drug wastage. Instructions for billing drug wastage specifically applies to single use vials. You could say it's the same thing, that would be your call. The difference, however, is that with a single-use vial, you can schedule two patients who both need the same thing (like botox for headaches) and avoid wastage (unless the scheduling just doesn't work out). But you cannot do that with a single-dose syringe; you can never give it to more than one patient. So I think that idea is out.

I would have a serious sit-down with my doc about substandards of care (because I read the actions our medical board takes on a regular basis), and just tell him they need to go somewhere else if that's what they want. But I'm the manager, and my boss and I have the kind of relationship where we can have this discussion. And I bribe him with kitkats - I have a whole bin of them on my desk just for him.