coding

When billing for a depo injection (96372), can we also bill 99211, 99212 or 99213 and if yes, what documentation is needed in the progress notes? Are vitals enough?

When billing for a gardasil vaccine (90649), besides billing the admin code (90471), can we bill a 99211 or 99212? If yes, what documentation is required in the progress notes?

Please respond to camsel@cmadc.com

Thank you.

re: coding

Hi ~

I can comment on the immunization; if the patient is there for the sole purpose of immunization update, you bill for the imm & admin only. If vaccine counseling is provided & pt is less than 19 yrs of age, use 90460/90461, as appropriate. IF they are seen for an illness or other concern not related to the imm it would then be appropriate to bill the E/M code 992xx-25 (depending on supporting documentation).

Hope this helps,

Cathy

p.s. I will also send to your email address provided

re: coding

My understanding is that the 96372 is included in the E/M and is not billable even with a 25 modifier. If the patient is not being charged for an E/M then you can bill the 96372...I work in an ortho practice and that is the way we do it, anyway.

re: coding

If the patient comes only for the injection or Vaccines then you need to report only Depo + 96372 or 90649 + 90471 in this case you should not report 99211 as it is bundled with 96372.

In some cases the patient may complaints of any illness for example fever for that condition if Nurse evaluate the patient and also did injection or vaccine that the nurse can eligible to bill 99211with 25 modifier along with 96372 or 90471.

If the Physician evaluated the patient for a different condition then we can bill 99212-99215 with 25 modifier depends upon the Level that the physician did along with 96372 or 90471.

Hope this will helps.