Coding Cues

October 20, 2006

Answers to your questions about...intranasal flu vaccine; next-day hospital admission; possible consult

Intranasal flu vaccine

What immunization administration (IA) code should I use for FluMist? Because this is an inhaled product, 90471-90472 seem inappropriate.

You're right; 90471-90472 is only for reporting IA of an injected product (immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; . . .). When you administer an intranasal (FluMist) or oral immunization, you should assign 90473-90474 (immunization administration by intranasal or oral route . . .).

If you perform and document an E&M service that's significant and separately identifiable from the immunization service, you should report the appropriate E&M code appended with modifier–25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

Next-day hospital admission

After I examined a patient in my office in the afternoon, I decided to admit him to the hospital. But I didn't see the patient in the hospital until the next morning. Which day should I report for initial hospital care?

Day Two. You should code the first time you see the patient in the hospital with 99221-99223 (initial hospital care, per day, for the evaluation and management of a patient . . .). These codes represent initial face-to-face services after hospital admission. In your case, you didn't see the patient in the hospital on Day One, so, for that day's care, you should report the appropriate-level E&M code (99201-99215) for when you treated the patient in your office.

If you had seen the patient in the hospital on the same day that you treated him in the office, you should report only 99221-99223 for that day. According to CPT's introductory notes for initial hospital care, "When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g., . . . physician's office . . .) all evaluation and management services provided by that physician in conjunction with the admission are considered part of the initial hospital care when performed on the same date as the admission."

Possible consult

A patient originally came to see me because he'd been referred for a procedure. I subsequently saw the patient a second time for a complication caused by the procedure. May I report a consult for the subsequent visit?

No. If the second visit was in your office, you should code the service as an established patient office visit using 99212-99215 (office or other outpatient visit for the evaluation and management of an established patient . . .). If it was in the hospital, code as subsequent hospital care with 99231-99233 (subsequent hospital care, per day, for the evaluation and management of a patient . . .). The subsequent visit is for managing the patient's condition, and you shouldn't consider it a consult.

But if the referring physician requested the subsequent inpatient consult visit, the encounter may qualify as a consultation (99251-99255). The patient's medical record should contain documentation of the request for opinion, rendering of findings, and report to the requesting physician.

This information is adapted from material provided by The Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact The Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592; or visit http://www.codinginstitute.com.