Wiki Nurse visit for an Immunization

[anita lapointe]

Hello..

I have a nurse visit where an immunization was the only thing done. There were no vitals documented, only the documentation of the immunization. How would you code this? I used 90471 plus the vaccine administered. However, a person in my billing department wants me to put E/M of 99211. Would that be appropriate? Thanks

 

[sueschreiner]

Cpc

You should only billed for CPT 90471 and the vaccine.....

 

[Pathos]

Yup, can't bill both the E/M and the procedure in this situation.

Some reading material:

https://www.aapc.com/blog/27690-know-when-to-bill-em-with-a-minor-procedure/

Excerpt:
"Per CMS rules, every procedure (whether major or minor) includes an “inherent” E/M component and, as such, you generally may not report a separate E/M service on the same date of service."

Unless documentation supports a modifier 25 and supports modifier 25 guidelines. Doesn't sound like this visit would though.

Hope this helps!

 

[Agilbert3]

99211 with 90471

There is a NCCI for 90471 and 99211 with modifier indicator 0. Which means there is no modifier that can be used to allow reimbursement for both codes at the same encounter.
I have seen some posts where people use modifier 25 for the nurse visit and vaccine admin code, but I wonder if it gets paid even if another issue was addressed.