Wiki Help with Immigration Green Card E/M billing

[LauraNewYork]

I'm still new to my place of work. I've recently run across charts where the patient is being seen only for immunizations/Green card immigration paperwork. Currently, patient's are only billed for the administration of the immunization(s). I believe a PE specific to immigration requirements is being done and the appropriate paperwork is being completed, but not billed for. This just doesn't seem right to me.

I reviewed ICD-10 and found Z02.89 - Encounter for immigration, but had trouble figuring out which E/M code would be appropriate. I could only find 99499 - Unlisted eval and management service.

I would appreciate input from anyone with experience in billing for Green Card Medical Exam/Vaccinations. What ICD-10 and CPT do you use and get successfully paid for? Or is this done only under vaccination?

 

[thomas7331]

I'd agree with using 99499 if you decide to bill these because this service is an administrative exam, similar to those done for school, sport, employment, commercial licenses, etc., and which don't fall into any of the other E&M categories. But I would recommend against billing these to insurance unless you're able to validate that this is something that the patient's plan covers. Because most plans exclude administrative exams from coverage, and because it's not a medical necessary service, the practices I've worked for would make these self-pay and require they be paid by the patient. If you do bill them routinely to insurance and get payment, I think there's a high probability that it would have been paid in error in which case you'd be at risk of having that payment recovered in the future when the error is discovered and then you'd be in the position of having to track down and bill the patient.