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Thread: Flu Shots

  1. #1

    Default Flu Shots

    AAPC: Back to School
    We are being told by the doctor to bill for a level 1 with each of the flu shots. Is this correct? When is it appropriate to bill a level 1 with a flu shot and when is it not? What documentation is needed? And will this work? Thanks

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    We do not bill a level 1 (99211) visit with the flu shots. We bill the administration and the vaccine. If there is physician counseling involved, then use the administration codes that include the physician counseling.

    Only bil a visit if a separately identifiable E/M is performed.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    Cindy is correct, when a patient presents for a scheduled service then you may not charge a E&M for that service or in addition to that service when a CPT code is available for the service. A flu shot is a service the patient schedules for and the assessment for the necessity has already been performed. So you may charge for the admin and the vaccine only. If the patient has an additional complaint then there needs to be a physician encounter in addition to the admin code.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4


    Do you have to charge both the admin charge and vaccine or can we just post the vaccine? I am asking because we have just a flat fee that we charge for flu shots?

  5. #5
    Join Date
    Apr 2007


    you have a flat fee for people that are self pay.... but if you are billing the ins then you would bill for the cpt flu shot and the admin or injection code...

  6. #6
    Join Date
    Apr 2007

    Default Flu Shots


    No 99211 for flu shots
    Can I code for a 99211 when I give an injection — say, a flu shot — if I also am checking vitals?
    You should not use the 99211 when delivering a flu shot if you are taking routine vital signs. Verifying that a patient is "OK" for a flu shot and making sure the patient is all right before leaving the office are components of the administration code. There are many payers that will not pay for code 99211 in conjunction with an injection code for just this reason. This code is actually a red flag for many payers since it is often misused. Instead, code just for the appropriate administration code (90471-90472) and the flu vaccine.
    Service Is Medically Necessary
    Question 4: Suppose a patient presents for a flu shot and also complains of a cough and congestion. Under office protocol, the nurse assesses the patient’s complaints, determines administering the vaccine presents no contraindications, and goes ahead with administration. Would 99211 be appropriate in this instance?


    Answer 4: Yes, because the nurse, under a physician’s orders, performs a medically necessary E/M to evaluate the patient’s chief complaint before administering the shot, you can bill 99211-25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

    Watch out: Buechner cautions the nurse must document the rationale for medical necessity, and that the E/M that supports the service.
    Heather Winters, CPC, CFPC

  7. #7
    Join Date
    Apr 2007


    Usage of CPT code 99211

    scenerio1: We have a walk-in clinic ( no appointment necessary) in our facility.Nurse counsel and administer the vaccine

    Scenerio2:Patient was seen by physician and he ordered for flu shot.Unfortunately it is out of stock.when we get medication nurse recall the patient. patient comes in [B](walk-in/no [/B]scheduled appointment)

    Please advise me is it appropriate to use 99211

  8. #8
    Join Date
    Apr 2007
    North Carolina


    I agree with the others. If the sole purpose is to receive the vaccination, 99211 is not appropriate.

    Where the sole purpose of an office visit was for the patient to receive an injection, payment may be made only for the injection service (if it is covered)


    Section 20.5.7

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