Gastroenterology Coding Alert

Question: I heard that there's a code we can bill (and be paid for) to indicate when our physician writes a prescription. What is it, and can we report it in addition to an E/M service? How about when a patient simply calls and the physician writes the prescription?


Florida Subscriber

Answer: You may be referring to V68.1 (Issue of repeat prescriptions). If the only reason the patient comes in, however, is to pick up a prescription and the GI does not see her for a documented E/M service, you cannot bill an E/M code.

In fact, CPT specifically includes writing prescriptions as part of an E/M service. This is just part of the cost of seeing patients, much like office supplies. There is no CPT code for writing a prescription that payers will reimburse.

Note: Prescription drug management supports a -moderate- level of risk, according to the table of risk found in the E/M documentation guidelines.

Although not a separately billable service, prescription drug management can help to support a higher level of service. You should associate a moderate level of risk with a level-four established patient office visit (99214) if the physician also documents multiple diagnostic/management options at this visit or orders or reviews a moderate number of tests.  

Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.