How to code E/M with immunization?

jticbs

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Orange, Anaheim, Los Alamitos CA
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Hi all, please help me with the scenario below. Thanks.

Dr. P.D. Trician saw a one and a half year old female for a well-child checkup. During a previous visit, Dr. Trician has counseled the patient's mother regarding the benefits and risks of these immunizations. MMR and DTP immunizations are given today by the nurse. Code for Dr. Trician.

My concern is the immunization are given by the nurse this visit, therefore no face-to-face with the doctor, correct? I use 90471 for DTP and add-on 90472 for MMR. My code will be:

99392-25, 90707,90701,90471,90472.
Let me know if this is correct. Thanks.

JT
 

LaVoncye

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Lizella, Georgia
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Coding for injection

if I am correct you cannot bill for the OV from the first visit with the Dr. This is considered a nurse visit 99211 because the Dr. did not see the patient. Depending on the insurance you may have to bill under the supervising physician and that Dr. needs to sign off on the chart. That primary code that you are billing is not correct. The modifier 25 is only of there were other services performed outside of the Well baby visit, such as another complaint.

If I am reading this correct the baby is comming back only for the immunizations not for a complaint and the nurse is administering the injection 99211 is your primary code.:) I hope this helps.:)
 

ewinnacott

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It actually sounds like the Dr saw the child on this visit for the well child and for the immunizations from what I'm getting from the original post, "Dr. P.D. Trician saw a one and a half year old female for a well-child checkup". He counseled the mom on the previous visit about the immunizations. So the original coding would be correct since you cannot bill the 90460 and 90461 for the counselling. 99392,90471,90472,90701,90707.

Can you please clarify on the well child visit? Were they seen the same day as the shots or on the previous visit where the mom was counseled about the immunizations?? If there was no visit, even if the nurse did the shots that day 99211 does not apply just the immunizations and administration
 

Pam Brooks

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I'm reading that the well child visit was done previously, and that the nurse is giving the shots today. In that case, for today's visit, I would bill only the immunization 90707 and 90701 with 90470 and 90471 since you didn't counsel by the physician on the same day as the vaccination. Immunization administrations are bundled into the 99211, per CCI, so you would not bill also the 99211.
 
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