you could not collect a copay up front for a planned flu shot or requested flu shot. You may not charge a 99211 for this and charge the admin fee plus vaccine code. If the patient brings up other issues which requires physician involvement, then at that point yopu can expalin to the patient taht a physician encounter is necessary and a copay will be required. Or you can reschedule for the another day. The nurse may not address new issues with the patient and charge an office encounter. Any issues regarding the flu shot is part of the administration charge. If the physician comes into the room then he must document an encounter for an issue unrelated to the flu shot. Because just like the physician cannot charge an E&M when the patient comes in for a scheduled procedure they cannot charge an E&M for a scheduled flu shot. A 99211 is truely not a nurse visit, it is a physician level, but it is the level the physician is allowed to charge when ancillary persons are in the room with the patient (while the physician is elsewhere in the office) to carry out orders from the physician in a previous encounter and no other code is available to use.
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