Answer to Question 1
Answer:
Immunizations are the administration of a vaccine or toxoid (a weakened form of the toxin) to stimulate the immune system to provide protection against a certain disease or condition. The actual immunization administration (codes 9636596368, 96372, 96374, 96375 as appropriate) is coded in addition to the immune globulins (9028190399), and/or vaccine or toxin (9047690749) which has been injected.
When an immunization is the only service provided, the evaluation and management code for a minimal service exam is also allowed. If the vaccine is provided by the government, the provider cannot bill for the product.
Even though these services may take several visits or take a prolonged period of time, these codes are not to be used with the codes for prolonged services. The prolonged amount of time has been included in the RVS amount for these codes.
Answer to Question 2
Answer:
A second opinion or confirmatory consultation is designed as a benefit to the patient by confirming the need for surgeries that have a reputation for being done needlessly. Normally, for an SSO benefit to be payable, the following requirements must be satisfied:
a. The second or third opinion physician must be totally uninvolved with the original recommending physician. Therefore, he or she cannot be part of the same medical group and will often be picked by the administrator, medical management firm, or payer.
b. The consultation must be completed before the scheduling of surgery.
c. The second opinion physician cannot perform the recommended surgery.
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