Gastroenterology Coding Alert

If your gastroenterology practice operates a qualified e-prescribing system, you're that much closer to a two percent Medicare bonus -- as well as preventing prescription errors and lowering consumer costs.

Your first step is to report one of the following denominator codes:

• E/M service codes 99201-99205 and 99211-99215;

• Outpatient consultation codes 99241-99245; or

• G codes G0108 (Diabetes outpatient selfmanagement training services, individual, per 30 minutes) or G0109 (Diabetes self-management training services, group session [2 or more], per 30 minutes).

Report any of these codes on the claim for each patient visit during the reporting period that meets the denominator coding criteria.

Report one of the following G codes on more than 50 percent of applicable Medicare cases for the numerator:

• G8443 -- All prescriptions created during the encounter were generated using a qualified eprescribing system

• G8445 -- No prescriptions were generated during the encounter, but the provider does have access to a qualified e-prescribing system

• G8446 0 -- Provider does have access to a qualified eprescribing system and some or all of the prescriptions generated during the encounter were printed or phoned in as required by state or federal law or regulations, patient request or pharmacy system being unable to receive electronic transmission; or because they were for narcotics or other controlled substances.

Remember: The applicable "G" code must go on the same claim as the "denominator" service.

Examples: A Medicare patient sees the gastroenterologist for chronic gastroesophageal reflux complaints. At the end of the E/M service, the gastroenterologist prescribes a proton pump inhibitor acid reducing medicine via e-scribing. You should report the service as follows, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel:

• 99213 (Office or other outpatient visit ...) linked to 530.81 (Gastroesophageal reflux), and

• G8443.

Similarly, a patient goes to the gastroenterologist for a diarrheal illness, suspecting that it may involve a foodborne infection. The gastroenterologist determines that the patient is merely suffering from a viral gastroenteritis, however, and orders only over-the-counter preparations.

Because the physician writes no prescriptions, you should bill the visit (a level 2) as follows, says Weinstein:

• 99212 (Office or other outpatient visit ...) linked to 787.91 (Acute diarrhea), and

• G8445.

Finally, a patient has chronic nausea and abdominal pain as a result of his chronic pancreatitis. The gastroenterologist documents a level 4 service. He orders some prescriptions via e-scribing, and the gastroenterologist writes a manual script for Vicodin on a paper script, because it is a controlled substance. You should report:

• 99214 (Office or other outpatient visit ...) linked to 577.1 (Chronic pancreatitis), and

• G8446.

One benefit of electronic prescribing is that it allows doctors to transmit prescriptions through a secure Internet network, through a clearinghouse, and ultimately to the pharmacies using an office or laptop computer or a digital handheld device.

Several studies have shown that e-scribing reduces prescription errors and cuts costs for consumers and health-care providers. It also encourages patients to get more of their prescriptions filled, because it reduces the waiting time spent at drugstores. Plus, this saves trips to the drug store for the patient, since he does not have to drop off the prescription first and then pick it up. With e-scribing, the patient does not have to drop off the script; he just needs to drop by the pharmacy to pick up his prescribed medications.

Also, Medicare released the new incentive guideline, which says: "Physicians who adopt e-prescription systems are eligible to earn a bonus of 2 percent of their total Medicare allowed charges." However, the rules on how you'll report your e-scribing will change next year.

Effective Jan. 1, you'll only report an e-prescribing code when a visit results in an electronic prescription being placed. You'll need to report this code at least 25 times during the reporting period to be considered a successful electronic prescriber.

Reality: Despite the efforts to turn e-scribing into a popular practice, many have yet to transition. For instance, none of the clients of a medical billing service in Novi, Mich. are currently using e-scribing, says the company's account leader. Some practices are hopeful that their program would kick off by early next year or thrive, as in the case of those who've just implemented e-scribing.

More information: You can review the final rule at www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf.