Orthopedic Coding Alert

Question: May we bill an insurance carrier for a prescription refill outside the global period, especially for patients who have to physically stop at the office to pick up a script? The staff and doctor spend a lot of time answering these inquiries.

Virginia Subscriber

Answer: No. 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 that payers will reimburse for writing a prescription.

If the only reason the patient comes in is to pick up a prescription and the orthopedist does not see her for a documented E/M service, you cannot bill an E/M code.

Note: Prescription drug management supports a “moderate” level of risk, according to the table of risk in the E/M documentation guidelines. Although prescription drug management is not a separately billable service, it can help to support a higher service level when your orthopedist does see the patient for a documented E/M visit that includes prescription management. You should associate a moderate level of risk with a level-four established patient office visit, 99214. (Remember, 99214 also requires either a detailed history or a detailed exam.)