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billing for EM when visits is for shots only

  1. Question billing for EM when visits is for shots only
    Medical Coding Books
    claims getting denied due to no supporting dx for the E/M, these visits are for kids that have not been seen for more than 6 months and are seen being the provider so shots can be ordered, we're billing only the v codes for the vaccines since these are not sick visit these are the only codes we can bill with, does any one have any suggestions on how to bill such visits?

  2. Default
    E/M visits must be medically necessary for insurance carriers to pay claims, thus the DX code. What service is the physician performing in addition to the immunizations?

  3. #3
    Is there a well visit with the shots? You have to have a non-IMZ ICD-9 for the E/M. We use V20.2 for a Well Child with a 9938X or 9939X depending on the age of the child. If it's IMZ only, why would you need an E/M? Try just billing the 90700 (Dtap) with V06.1, (Example) and no E/M if there was no Well Child visit. I'm guessing there would be some sort of Well Child visit (which needs a V20.2, if asymptomatic), or it should have been a nurse only visit to give shots, in which a 99211 or no E/M at all, IMO.
    Heidi Thompson, CPC

  4. Default
    thanks for your responses, sounds like our appt scheduler needs to stop scheduling appt for shots only or to schedule these types of visits with the nurse.

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