Page 2 of 2 FirstFirst 12
Results 11 to 15 of 15

Separate administrations of flu vaccines

  1. #11
    Medical Coding Books
    Also... another way to look at the issue of two vaccines... yes we normally give 1 flu vaccine per year however it is widely accepted as standard to give two under the previously mentioned circumstances. Just as it is standard to give 3 HPV vaccines. You wouldn't consider not charging for the second and third HPV vaccine just because you had given it before. (at least I hope you wouldn't ) Just a thought to maybe help some of you wrap your minds around charging for both.
    Barbara Haskins CPC

  2. Default Regarding billing 99211 with flu vaccine in FQHC
    In a FQHC, flu vaccines and pneumo vaccines are included on the Medicare Cost Report.
    99211 visits cannot be billed as a FQHC encounter.
    A FQHC billable service must include a face to face visit with a core provider. Clinical assistants or nurses are not core providers.

    If you provide a flu vaccine or pneumo vaccine you should claim the appropriate administration code (90471) along with your vaccine code on your cost report.

    Cms raised the RVU value of 90471 so billing a 99211 in addition to this is incorrect unless you have a medically necessary diagnosis to support billing 99211 in addition to the administration code for the flu vaccine.

    If you do have a medically necessary diagnosis go ahead and bill 99211 to Medicare Part B only.
    Claim the cost for the admin and flu vaccine on your Medicare cost report.

  3. #13
    I do not bill Medicare (not much call for it in pediatrics) so I can't speak to how to bill Medicare specifically.

    I agree that 99211 should not be used unless there is a medically necessary diagnosis.

    I also just wanted to clarify that it is not appropriate to code 90465-68 unless the physician counsels the patient on the same date of service. If the patient comes in for the sole purpose of a flu vaccine and does not see the physician; 90471-74 would be the correct series to use for the administration of the vaccine.
    Barbara Haskins CPC

  4. #14
    When would you code a 99211 E/M level for a flu shot? That does not seem appropriate to me, counseling and risk is included in all procedural services provided. If another diagnosis is addressed or assessed during the same visit by a privileged provider and meets the minimum 2 out of 3 requirement a level 2 with a modifier 25 should be assigned at the very least. If the 2 out 3 requirment is not met then a 99211 would be appropriate. Nurses/MA are not allowed to address/assess another diagosis without a physicians order.
    Last edited by maysons1703; 11-17-2008 at 01:18 AM. Reason: dh

  5. #15
    I was only addressing a previous comment about 99211. We rarely if ever use it in conjunction with giving a flu shot... 9 times out of 10 if there is a complaint that requires e/m a physician steps in to handle the encounter. There are certain specific situations in our office that our RN's have been given authority by the physicians to triage... if this goes beyond the services covered by the administration codes we will code a 99211.

    Don't forget you can code an e/m based on time also if more than 50% of the time spent was counseling... for a 99211 that would equal 2.5 minutes.
    Last edited by bhaskins1; 11-17-2008 at 10:06 AM. Reason: spelling
    Barbara Haskins CPC

Page 2 of 2 FirstFirst 12

Similar Threads

  1. Flu Vaccines
    By bethb in forum Medicare Regulations
    Replies: 3
    Last Post: 10-13-2015, 01:09 PM
  2. Multiple vaccines administrations same day
    By DMAndre in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 06-12-2010, 06:42 AM
  3. Multiple vaccines administrations same day
    By DMAndre in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 06-09-2010, 05:50 PM
  4. Replies: 7
    Last Post: 01-20-2010, 01:58 PM
  5. Flu vaccines
    By jnieto625 in forum Family Practice
    Replies: 4
    Last Post: 10-15-2008, 01:01 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?


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.