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New patient being seen by doctor but only to get a vaccine

Willow Posted Fri 05th of October, 2012 15:43:59 PM

We are trying to decide how to handle new patients who want to come in just for flu vaccine. Parent declines well visit because it "isn't due yet" (insurance wouldn't cover an "extra" check-up), but we are not comfortable bringing in a totally new patient to just have an MA do a vaccine - we want them to see a doctor for a brief visit to establish, and then have the MA do the vaccine. (A well visit in a few months is expected.) What diagnosis code could be used for the visit, assuming the patient has no medical issues? Thank you!

SuperCoder Answered Fri 05th of October, 2012 19:59:18 PM

Hi Willow,

We are working on this. Please be patient.


SuperCoder Answered Tue 09th of October, 2012 10:43:08 AM

Hi Willow! Typically if it is a new patient, the insurance will pay for the "additional" preventive medicine visit, even if it is less than a one year interval. If not, I would agree that the practice will either accept they will provide a brief preventive medicine visit at no charge as a practice builder, or bill a reduced preventive medicine visit (52 modifier) which the family will be responsible for "out of pocket". In this situation, having the family sign an ABN is optimal to avoid any misunderstanding.

Torrey Kim, CPC, CGSC
Editor, Pediatric Coding Alert

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