Coding 96372 with 90471

During an office visit, our nurse administered a B12 injection and a flu shot to an established patient. Can we code for both injections apart from the office visit?

Well, it all depends on the circumstances. First report the proper code for the flu vaccine (example 90658, “Influenza virus vaccine, split virus, when administered to individuals three years of age and older, for intramuscular use) depending on the type of vaccine administered as well as the proper code for the administration of the vaccine like 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]). If the administration involved physician counseling with a patient 18 years of age or younger, you'll report 90460 for the administration; for a Medicare patient, the administration code is G0008 (Administration of influenza virus vaccine).

For the B12 injection, report the administration with 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). Include J3420 (Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg) for the vitamin B-12 itself.

In the end, if the office visit was significant and separately identifiable from the two injections, you may add the proper office visit code from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …). In this case, make it a point to append modifier 25 (Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service) to the office visit code.

There are exceptions: If the patient gets the B12 shots as part of a scheduled administration plan which otherwise involves no E&M of the patient, go for the flu shot and the B-12 injection, but not the office visit.