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Requirement for a medical order

A nurse requires a prescription from a physician or registered nurse in the extended class [RN (EC)] in order to administer the vaccine and emergency treatment for anaphylactic reaction.
For billing purposes, the requirements for delegated procedures apply to physician delegation to the RN(EC) and RN.

Diagnostic Code

In order to improve monitoring of the effectiveness of the influenza vaccine, enter the correct diagnostic code, 487, in the diagnostic code field on the item record of the claim for all consultations, visits or procedures, including those in an emergency department, that are rendered for treatment of influenza.

Inquiries

  • Additional information about influenza, the vaccine and where to get a flu shot is available from the Ministry of Health and Long-Term Care by calling
    Toronto416-327-0427
    Toll free1-866-FLU‘N-YOU (1-866-358- 6968)
    TTY1-800-387-5559

 Questions and Answers

  1. If a physician writes orders for nursing staff to administer flu shots to patients in a long-term care facility or hospital, can the physician bill OHIP for the service?
  2. No. The nursing staff are employees of the facility rather than the physician and the facility is providing the personnel, premises, equipment and supplies for the service. This situation does not meet the requirements of a delegated procedure.

  3. A physician has scheduled appointments for patients to receive flu shots from the office nurse while the physician is absent from the office. This nurse is employed by the physician's practice. Can the physician bill OHIP for a delegated vaccination without the physician being present?

No. The physician must be physically present in the office or clinic in order to claim for immunization services performed by the physician's nurse. This situation does not meet the requirements of a delegated procedure.


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Ontario Ministry of Health and Long-Term Care
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