Revenue code 761 for a treatment room should typically be billed with a procedure code reflecting the treatment, not with an E/M code. In addition, it is not appropriate to use an E/M code unless an assessment/work-up of the patient’s signs/symptoms occurs. Because the CPT codes for the rabies vaccine (90675) and the immunization administration (90471) are considered “incident to” services, they must be billed with an E/M code (under Medicare) or the claim will be denied. The following are two options to have these claims paid:
• Indicate to the physician that the patient will have to pay for the immunization because it is considered an “incident to” service and therefore is not covered by Medicare.
• Determine how often this issue occurs. If it is recurring, consider developing an internal protocol to assess this patient before and after the administration of the vaccine, document the assessment appropriately, and charge a low-level E/M visit along with the vaccine and the immunization administration.
