In my office we bill the Protime/INR checks performed by the nurse (with appropriate documentation which supports the service) as follows:

We have never had a problem billing this way, until now. Some of our patients that come in for their Protime visit are asking to get the Flu Shot. So we also bill:

Medicare is denying the 99211 as “Included in the primary procedure”. I was told, when I called Medicare that I needed to add a modifier to signify that the 99211 was separate from the flu shot, so I added the 25-mod, and it's still getting denied…. Is anyone else having this problem???