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E/M services provided on the same date as vaccine administration When an evaluation and management (E/M) service (other than a preventive medicine service) is provided on the same date as a prophylactic immunization, modifier 25 may be appended to the code for the E/M service to indicate that this service was significant and separately identifiable from the physician's work of the vaccine counseling/administration

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Haematological responses typically occur within 1-2 weeks, but neurological recovery may take months and can be incomplete if the deficiency has been prolonged