Ophthalmology and Optometry Coding Alert

Question: My physician heard that there's a code we can bill and be paid on for the writing of a prescription. Is there such a code and, if so, can we report it in addition to an E/M service and/or when a patient calls in and the physician simply writes a prescription?


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Answer: There is no CPT code that you should report when your physician writes a prescription for a patient. CPT specifically includes writing prescriptions as part of an E/M service. Your office should just consider prescription writing as part of the cost of seeing patients. Coding solution: If someone in your office, either the physician or a nurse, is seeing the patient and, during the course of the encounter, writes a prescription, you should include it as part of medical decision-making (prescription drug management) when determining the level of E/M service to assign. For example, use it as part of medical decision-making to assign an established patient code (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...). Caution: It would not be appropriate for a nurse to report an eye code; however, if the ophthalmologist examined and treated a patient, he may be able to report an eye code that also includes the rendering of a prescription. Pointer: Prescription drug management supports a "moderate" level of risk, according to the table of risk found in the E/M documentation guidelines. Keep in mind that "risk" is only one of the components used to determine the overall level of MDM. You will need to consider the number of diagnoses or management options, as well as the amount and/or complexity of data to be reviewed. While not a separately billable service, prescription drug management may support a moderate level of MDM during a documented E/M visit-- if one of the other elements of MDM is at least of moderate complexity. Prescription management alone does not equal moderate MDM or support a level-four code assignment. But if the only reason the patient is coming into your office is to pick up a prescription and neither a physician nor a nonphysician practitioner sees her, you should not report an E/M service. This service, if documented, may accrue to the medical decision-making of a subsequent E/M service. Diagnosis option: There is a diagnosis code that might be appropriate for you to report -- V68.1 (Issue of repeat prescriptions). You should use V codes to provide additional clinical information to an insurer, whether it's Medicare or a private carrier. Note: V codes do not really increase your payments but instead paint a clinical picture of the patient's condition. Advice for You Be the Coder and [...]