Results 1 to 7 of 7

Flu Vaccine a Professional Service?

  1. #1
    Location
    Overland Park, KS
    Posts
    1,166
    Default Flu Vaccine a Professional Service?
    Medical Coding Books
    I have a very interesting scenario that I would like guidance on please.

    Per CPT Assistant, a new patient is one who has not received any professional services for the physician (provider), or another physician (provider) of the same specialty who belongs to the same group practice, within the past three years. An established patient is one who has received professional services for the physician (provider), or another physician (provider) of the same specialty who belongs to the same group practice, within the past three years. They go on to say that a new vs. an established patient does not necessarily mean a face-to-face encounter, but professional services. They say that if the patient has received a professional medical service from the provider, other than for administrative reasons then the patient would not be considered a new patient, but rather an established patient.

    Now for my question, if a patient comes in for a flu vacicne only and is seen by an NP for the administration of the flu vaccine, then is the flu vaccine considered to be a professional service that would "establish" the patient?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Absolutely.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks. What if the patient was new, but only saw the nurse (RN) for the vaccine? Would this establish care as well or is the deifferance the provider (RN vs. NP)?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    You cannot have a new patient see only the nurse and bill for that service. The nurse services are always billed under the physician as incident to services and you cannot do that for new patients.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Ok. So let's say that a new patient came into our clinic for a flu vacicne only that was been done as part of a flu clinic and was being roster billed. No NP or MD present just RNs because it is a flu clinic only. We give the flu vaccine and then a couple of weeks later the patient returns for a sick visit with the MD, then is this patient new or established?

    I'm thinking because it was roster billed by the RN only and not under the NP or MD, that this would make them a new patient. If it was billed under the NP or MD's NPI and they supervised the services, then this would establish the patient. Am I on the right track here?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Default
    Remember the following regarding the influenza vaccine:

    •Medicare allows one influenza (flu) vaccination per year;
    Medicare does not require for coverage purposes that a doctor of medicine or osteopathy order the influenza vaccine and its administration; and
    •The beneficiary may receive the influenza vaccine upon request without a physician's order and without physician supervision.


    http://www.cms.hhs.gov/MLNMattersArt...ads/MM6121.pdf

    The simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass pneumococcal and influenza virus vaccination programs offered by PHCs and other individuals and entities that give the vaccine to a group of beneficiaries, e.g. at PHCs, shopping malls, grocery stores, senior citizen homes, and health fairs.

    http://www.cms.hhs.gov/manuals/downloads/clm104c18.pdf

    10.3


    Dawson,

    If the patient received the flu shot and the claim was submitted by roster billing, the return, face to face, visit with the physician would be considered new...assuming there was no previous face to face with that physician or same specialty physicians within that group (within the last 3 years).

  7. #7
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks so very much for clarifying this. I owe you one.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

Similar Threads

  1. Flu vaccine help
    By TLC in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-17-2015, 11:42 AM
  2. Flu vaccine
    By KBounaouar in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 12-28-2014, 11:01 PM
  3. Site of Service / Place of service for professional claims?
    By Denise in forum Outpatient Facilities
    Replies: 0
    Last Post: 03-14-2012, 06:41 AM
  4. flu vaccine
    By Bellaboo in forum Internal Medicine
    Replies: 1
    Last Post: 10-06-2011, 10:10 AM
  5. E/M and Flu Vaccine
    By dballard2004 in forum Family Practice
    Replies: 1
    Last Post: 08-05-2009, 01:34 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.