Ophthalmology and Optometry Coding Alert

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


New Jersey Subscriber


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, you should report the appropriate E/M code--for example, an established patient code (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...).

However, incident-to guidelines must be met to report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician), which means there must be a plan of care with medical necessity for the patient to be seen by the nurse. There must also be documentation to support the visit, and the supervising physician must be immediately available in the office suite.

But if the only reason the patient is coming into your office is to pick up a prescription and she is not seen by a physician or nonphysician practitioner, you can't even report an E/M service. Note, however, that this service, if documented, may accrue to the medical decision-making of a subsequent E/M service.

Diagnosis option: There is a diagnosis code, V68.1 (Issue of repeat prescriptions), which might be appropriate for you to report.