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Billing office charge for injection only?

  1. #1
    Cool Billing office charge for injection only?
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    Hello everyone, I need every opinion on this one...this is the second time this month I have received 2 physicians trying to bill office visit charges 99214 etc. but only reason patients came is because they are going to travel overseas and need to have some injections/vaccines. I agree with a second coder that we should only bill the injection, however the physician did a complete physical exam. (but patients are not complaining of anything) What you guys think it should be the proper way to bill this?
    Mildred Nieves, CPC

  2. Default
    If they came in as a planned procedure, then only the injections are coded. This would be likley for an Est patient that the physican already knows. The CC is "pt here for shots"

    But, the physician also has the right to perform a medical exam to eval the patient for any medical issues that would affect the decision to travel overseas or if there were any chronic conditions that would exclude getting one of the shots.

    He has the right to say "I won't give you these shots without an exam". The patient also has the right to say "Never mind, I dont need an exam, I'll go down to the Health Dept for the shots" (that would be my response).

    But what would be the CC? The patient has no complaints. It would be hard to support medical necessity for a level 4 especially if your DX is only a V03-V06 code. In reality, shots can be given by the nurse.

    It comes down to: did the physician have medical necessity to perform a level 4 eval on these patients? Or is he padding?
    Last edited by sbicknell; 06-13-2010 at 05:51 PM.

  3. #3
    Hi and thanks for your reply I do agree with your opinion. But in this cases there is not CC at all. And is seem that it was not planned.
    Mildred Nieves, CPC

  4. Default
    We have a physician at our facility that provides services to patients who are traveling outside of the country. He does an exam and counseling and provides shots. We charge 99401-99404 for individuals and 99411-99412 for groups, i.e. a couple or a family that are traveling outside of the country. These are time based codes so there will need to be mention of how much time was spent.

    We also charge for the immunizations.

    The diagnosis for the "office visit" is V65.49.

    I hope this helps.

  5. #5
    I am trully learning a lot here, so did you get full reimbursement for all insurance with these codes? Thanks a lot for sharing that information.
    Mildred Nieves, CPC

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