Billing CPT® 99211 along with 90471

The patient comes in for their Protime check, this requires the nurse to discuss the results in-depth with the patient. Therefore, we would bill a 99211. During the same visit, the nurse also administers a vaccination (e.g., flu shot, tetanus, etc.), which would result in a 90471 (administration charge). Can we bill both the 99211 and the 90471? If yes, is a modifier 25 required on the 99211?

re: Billing CPT® 99211 along with 90471

Was the service medically necessary and not just routine Pro time with normal results, (there must be a change in the medical regimen performed while the patient is in the office)? You only bill 99211 for a Pro-time IF the results are abnormal.
If abnormal:
The PT/INR levels indicate a needed change in the anticoagulant dosage. This also meets the “medical necessity requirement”
The nurse informs the patient of the changes and documents this in the patient’s record while the patient is in the office which meets the “face-to-face requirement”

re: Billing CPT® 99211 along with 90471

Yes, the Protime was abnormal. We only bill a 99211 when it is abnormal and the nurse needs to discuss changes. If it is a routine check, we will only bill the 85610. In the case I have, and others we billed the 99211 because of abnormal readings, then the patient got the flu vaccination also. So can we bill both 99211 and 90471? Is modifier 25 needed on 99211. Insurances are denying the 99211 as being inclusive of another procedure, which would be the 90471. We did not have a modifier on the 99211. Thank you

re: Billing CPT® 99211 along with 90471

Make sure you link the condition for the Pro-time and code 790.92 to 99211. Link the V code for flu injection to 90471 (non-Medicare) code. G0008 is administration code for flu injection for Medicare.

re: Billing CPT® 99211 along with 90471

There is a great article on this issue on this site in the archives at http://codapedia.com/article_485_Reporting-Administration-Codes-with-Vaccines.cfm you may want to take a look at it in its entirety. Here is a excerpt that may be helpful "Vaccines and Evalualtion and Management Codes
National Correct Coding Initiative (NCCI) edits do not allow 99211 to be billed with any vaccine administration codes (90465-90474). For separately billable evaluation and management (E/M) services performed on the same day as vaccines, add modifier 25 to the E/M code."