RileighK_78039
New member
My boss wants to have a “flu clinic” for his ALF Medicare and clinic patients. Would it be appropriate for our facility to code with a low level complexity E/M code (99211 or 99212) in addition to Z23 and G0008?
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Resolved E/M code for flu vaccine for Medicare patients?
- Thread starter RileighK_78039
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Lori
Well-known member
I will have Alicia chime in but I do not think an E/M code because there was no visit with the provider.
If other problems were addressed, then you would use an E/M with modifier 25. If no other problems were addressed, and an E/M code along with the flu shot codes were billed, that would be a problems that is the kind of issues CMS is looking for. But if a completely separate E/M service is performed, supported by the required elements for the level billed, and different diagnosis code, then you are absolutely justified in the E/M with mod 25.
Coverage of other vaccines provided as a preventive service may be covered under a patient's Part D coverage.
www.aafp.org
If other problems were addressed, then you would use an E/M with modifier 25. If no other problems were addressed, and an E/M code along with the flu shot codes were billed, that would be a problems that is the kind of issues CMS is looking for. But if a completely separate E/M service is performed, supported by the required elements for the level billed, and different diagnosis code, then you are absolutely justified in the E/M with mod 25.
Medicare Part B: Vaccine Coverage
Medicare Part B provides preventive coverage only for certain vaccines. These include:- Influenza: once per flu season (codes 90630, 90653, 90656, 90662, 90673-74, 90682, 90685-88, 90756, Q2035, Q2037, Q2039)
- Pneumococcal: (codes 90670, 90732, once per lifetime with high-risk booster after 5 years)
- Hepatitis B: for persons at intermediate- to high-risk (codes 90739- 90740, 90743-90744, 90746-90747)
- G0008 administration of influenza virus vaccine
- G0009 administration of pneumococcal vaccine
- G0010 administration of Hepatitis B vaccine
- Z23 Encounter for immunization
Coverage of other vaccines provided as a preventive service may be covered under a patient's Part D coverage.
Medicare Part B and Part D Vaccine Coverage
Find out what vaccine coverage is offered by Medicare Part B and Part D.
MLN006559 – Medicare Preventive Services
Preventive Services Chart. Learn about codes; who is covered; frequency; and what the Medicare patient pays.
www.cms.gov
RileighK_78039
New member
Thank you SO much Lori! I have no one else to discuss coding with so I really appreciate you and the community of CCO and the facebook groups you admin for taking the time to give me your valuable input and direction. I feel confident in the findings of my research, I will relay the information I have to my superiors.I will have Alicia chime in but I do not think an E/M code because there was no visit with the provider.
If other problems were addressed, then you would use an E/M with modifier 25. If no other problems were addressed, and an E/M code along with the flu shot codes were billed, that would be a problems that is the kind of issues CMS is looking for. But if a completely separate E/M service is performed, supported by the required elements for the level billed, and different diagnosis code, then you are absolutely justified in the E/M with mod 25.
Medicare Part B: Vaccine Coverage
Medicare Part B provides preventive coverage only for certain vaccines. These include:
Administration services for these preventive vaccines are reported to Medicare using HCPCS codes as follows:
- Influenza: once per flu season (codes 90630, 90653, 90656, 90662, 90673-74, 90682, 90685-88, 90756, Q2035, Q2037, Q2039)
- Pneumococcal: (codes 90670, 90732, once per lifetime with high-risk booster after 5 years)
- Hepatitis B: for persons at intermediate- to high-risk (codes 90739- 90740, 90743-90744, 90746-90747)
The diagnosis code to report with these preventive vaccines is:
- G0008 administration of influenza virus vaccine
- G0009 administration of pneumococcal vaccine
- G0010 administration of Hepatitis B vaccine
Other immunizations are covered under Medicare Part B only if they are directly related to the treatment of an injury or direct exposure (such as antirabies treatment, tetanus antitoxin, or booster vaccine, botulin antitoxin, antivenin, or immune globulin)
- Z23 Encounter for immunization
Coverage of other vaccines provided as a preventive service may be covered under a patient's Part D coverage.
Medicare Part B and Part D Vaccine Coverage
Find out what vaccine coverage is offered by Medicare Part B and Part D.
MLN006559 – Medicare Preventive Services
Preventive Services Chart. Learn about codes; who is covered; frequency; and what the Medicare patient pays.www.cms.gov
- Status