tci Medicare Compliance & Reimbursement - 2013 Issue 16

Reader Question: Note That Immunization by MA Doesn't Usually Qualify for E/M

Question: This is the first year we are considering providing FluMist without a physician visit. Our medical assistants (MAs) will be administering the shot after the patient fills out a questionnaire. The MAs do not qualify to bill 90460. Should we report 90471 or 90473 for the FluMist? Or should we opt for 99212? Answer:  Your best bet is to bill 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]). You cannot report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2...

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