I work for a small family practice. We often see patients for annual exams. Our Dr. has been providing other services on the same day as annuals. Anywhere from vaccines to lesion removals. I’ve billed out for additional services in the past with an E/M visit and modifier 25 attached and have gotten the claims paid. Recently I have been getting denials on the annual code and paid on the additional service. Our manager has spoken to our Dr. about scheduling a separate appointment for procedures but not for vaccines. He likes to save his patients a trip back to our office. The vaccines used are not state supply. Is there any way I can bill out for the admin/vaccines with an annual exam with out getting a denial?