Separate administrations of flu vaccines

[bhaskins1]

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.

[Sheryl.McCormick]

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.

[bhaskins1]

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.

[maysons1703]

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.
Melissa

[bhaskins1]

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.