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Wiki Flu vaccination billing

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kumeena

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Bellerose, NY
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Good Afternoon Everyone,

In our hospital any patient can get flu shot (walk-in) . RN can give flu shot without provider's order.

Patient was seen by a Nurse practioner (Primary clinic) and he/she got the flu vaccination.

Provider did not order for vaccine.

As per Medicare they are looking for modifier 25 with E/ M code.

How do I justify modifer 25 with provider E/M code?

Thank you
 
Last edited:
Why are you using an E/M code? why not just bill for the flu and its admin? We are primary care, and plenty of times just have patients come in for nothing but a flu shot..the nurse gives it, and we don't bill an E/M code because there was no visit with the provider.
 
kumeena said:
patient was seen by nurse practioner for other problems and NP used E/M code. So we have to use E/M code.
Click to expand...

The fact that other problems were addressed, is the justification for using modifier 25. If no other problems were addressed, and an E/M code along with the flu shot codes were billed, that would be a problem. That is the kinds of issues CMS is looking for. But if a completely separate E/M service is performed, supported by the required elements for the level billed, and different diagnosis code, then you are absolutely justified in the E/M with mod 25.

HTH!
 
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