Gastroenterology Coding Alert

Question: We have to complete Rx authorization forms in order to get some insurers to pay for proton pump inhibitors such as Prilosec. Can we bill code 99080 to get reimbursement for completing these forms?

Illinois Subscriber

Answer: It is questionable to bill 99080 (special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) in your situation and even more questionable whether any insurer will reimburse you for it.

It may not be appropriate for two reasons. First, the CPT manual states that this code is to be used when a reporting physician completes the special form. Often, Rx authorization forms are filled out by nonphysician providers or staff members.

Second, the code is to be used when more than the normal amount of information is conveyed in the usual medical communications. Examples of such forms include detailed reports related to accidents, injuries or workers compensation. While Rx authorization forms are not specifically included or excluded by the CPT, it is doubtful that most payers will consider the Rx authorizations anything other than brief standard reports.

This months reader questions were answered by Pat Stout, CMC, CPT, an independent gastroenterology coding consultant and president of OneSource, a medical billing company in Knoxville, Tenn