Otolaryngology Coding Alert

Question: I’ve heard that there’s a code we can bill (and be paid for) to indicate when our physician writes a prescription. What is it, and can we report it with an E/M service? What if the patient simply calls and the physician writes the prescription?

Florida Subscriber

Answer: The diagnosis code you are referring to is probably ICD-9 code V68.1 (Issue of repeat prescriptions). But this is a reason for a service, not a code for a service.  But if the only reason the patient comes in is to pick up a prescription and the physician does not see her for a documented E/M service, you cannot bill an E/M code.

Insurance carriers consider prescription writing as part of the cost of seeing most patients, much like office supplies. There is no separate CPT code for writing a prescription that carriers will reimburse. Additionally, most insurance companies do not pay for non-face to face services.

Note: Prescription drug management supports a “moderate” level of risk, according to the table of risk found in CPT’s E/M documentation guidelines. Although not a separately billable service, prescription drug management can help to support a higher service level when it is part of a face to face E/M service.

You should associate a moderate risk level with a level-four established patient visit (99214) if the physician also documents multiple diagnostic/management options at this visit or orders or reviews a moderate number of tests and at least a detailed exam or a detailed history is performed.