Oncology & Hematology Coding Alert

Physicians who adopt e-prescription systems are eligible to earn a bonus of two percent of their total Medicare allowed charges. But the rules on how you'll report your e-prescribing will change for 2010, so take heed.

Narrow 2010 Option to G8553

2010: CMS issued a new numerator G code with the following descriptor:

• G8553 -- At least one prescription created during the encounter was generated and transmitted electronically using a qualified ERX system. Effective Jan. 1, you'll report an e-prescribing code only when a visit results in an electronic prescription being placed. You'll need to report this code at least 25 times (unique visits) during the reporting period for Medicare to consider you a successful e-prescriber. You also need to be sure that this measure's denominator codes make up 10 percent of the eligible professional's Medicare Part B charges. The denominator codes you're likely to use most often for oncology are office and outpatient E/M codes 99201-99215.

2009: In contrast, in 2009, you reported on 50 percent of applicable cases and had more coding options:

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

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

• G8446 -- Provider does have access to a qualified e-prescribing 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.

Oncology & Hematology Coding Alert/2010, Vol. 12, No. 1 To subscribe, call (800) 508-2582 Page 5

Example: Mr. Patient, who has chronic myeloid leukemia, sees Dr. Oncologist for recurring treatment. Dr. Oncologist performs a level four established patient office visit and e-prescribes the renewal of Mr. Patient's oral medication.

In both 2009 and 2010, you report the denominator code 99214 (Office or other outpatient visit for the evaluation and management of an established patient ...) and appropriate ICD-9 code, such as 205.10 (Myeloid leukemia; chronic; without mention of having achieved remission, failed remission). But the e-scribe code differs. In 2009, you report G8443, but in 2010, you'll report G8553.

Tip: If 2010 will be your first time participating, contact your local pharmacies to ensure they are ready to receive your e-prescriptions. "This can be the difference between success and failure," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in New Jersey.

Resources: You can learn more, including all eligible denominator codes, at CMS's E-Prescribing Incentive Program page: www.cms.hhs.gov/ERxIncentive/01_Overview.asp.