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Flu vaccination billing

  1. #1
    Default Flu vaccination billing
    Medical Coding Books
    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 by kumeena; 10-17-2014 at 08:18 AM.

  2. Default
    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.

  3. #3
    patient was seen by nurse practioner for other problems and NP used E/M code. So we have to use E/M code.

  4. #4
    Baton Rouge
    Quote Originally Posted by kumeena View Post
    patient was seen by nurse practioner for other problems and NP used E/M code. So we have to use E/M code.
    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.

    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  5. #5
    Thank you .

    Have a nice weekend.

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