miugu
Networker
Should/can an E/M code be billed for a vaccine only visit? We are not billing an E/M, but I hear that you can bill 99211 or 99212. Is that correct?
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Vaccine Only Visit
- Thread starter miugu
- Start date
SharonCollachi
Guest
Was the vaccine already ordered by the doctor? Just bill the vaccine administration and vaccine.
AmandaBriggs
Expert
This is from chapter 11 of the NCCI manual:
14. If one or more immunizations and a significant, separately identifiable E&M service are rendered by a physician on the same date of service, both the immunization administration code (e.g., CPT codes 90460–90474) and the E&M code with modifier 25 appended may be reported. If the patient returns on another day solely to receive another immunization, only the immunization administration code shall be reported.
15. Similar to drug and chemotherapy administration CPT codes, CPT code 99211 (Evaluation and management service, office or other outpatient visit, established patient, level I) is not separately reportable with vaccine administration HCPCS/CPT codes 90460-90474, G0008-G0010. Other E&M CPT codes are separately reportable with a vaccine administration code if the E&M service is significant and separately identifiable, in which case the E&M CPT code may be reported with modifier 25.
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd
14. If one or more immunizations and a significant, separately identifiable E&M service are rendered by a physician on the same date of service, both the immunization administration code (e.g., CPT codes 90460–90474) and the E&M code with modifier 25 appended may be reported. If the patient returns on another day solely to receive another immunization, only the immunization administration code shall be reported.
15. Similar to drug and chemotherapy administration CPT codes, CPT code 99211 (Evaluation and management service, office or other outpatient visit, established patient, level I) is not separately reportable with vaccine administration HCPCS/CPT codes 90460-90474, G0008-G0010. Other E&M CPT codes are separately reportable with a vaccine administration code if the E&M service is significant and separately identifiable, in which case the E&M CPT code may be reported with modifier 25.
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd