CODING & DOCUMENTATION

 

Fam Pract Manag. 2017 Jul-Aug;24(4):37.

Flu shot timing

Q

Does Medicare cover influenza immunizations as soon as new vaccines are available, or are they payable only after a certain date?

A

Physicians may provide immunizations as soon as new seasonal vaccines are received in order to avoid missed opportunities to immunize patients, and Medicare provides coverage. Medicare covers influenza immunization once per influenza season. A second immunization may be covered as well if it is medically necessary. The Centers for Medicare & Medicaid Services (CMS) issues seasonal vaccine payment allowances that are effective Aug. 1 (http://go.cms.gov/2qYQBKH). Charges for vaccines provided prior to Aug. 1 may be paid at the rates of the prior influenza season. Be sure to also check your Medicare administrative contractor's instructions regarding billing and payment for new influenza vaccines.

Documenting subsequent nursing facility visits

Q

What documentation is required to support billing for a subsequent nursing facility visit (CPT 99307–99310)?

A

According to CPT, documentation must include two of the three key components or a statement that more than 50 percent of the unit/floor time devoted to an individual patient was spent in counseling and/or coordination of care. For Medicare patients, documentation must also include evidence of a face-to-face encounter and medical necessity for the level of service rendered. CMS also notes that a large number of patient visits by a single physician on the same date may raise suspicion of “gang visits” and may require documentation to substantiate that visits were either medically necessary or federally mandated. As with all services, the physician or qualified health care professional must authenticate the record with a written or electronic signature including credentials and date.

Billing for intravenous hydration

Q

If a patient is provided intr

About the Author

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Cindy Hughes is an independent consulting editor....

Author disclosure: no relevant financial affiliations disclosed.

Reviewed by the FPM Coding & Documentation Review Panel: Kenneth Beckman, MD, MBA, CPE; Robert H. Bösl, MD, FAAFP; Marie Felger, CPC, CCS-P; Thomas A. Felger, MD, DABFP, CMCM; Emily Hill, PA-C; Joy Newby, LPN, CPC; and Susan Welsh, CPC, MHA.

WE WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.

 
 

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