Compensation Tips for Phoning in Prescriptions
Published on Sun Feb 01, 1998
In the old days, pediatric practices could afford to absorb the costs of calling pharmacies with prescriptions. Now, because of managed care, this service is becoming burdensome and costly. Below several pediatricians and a practice manager share their tips for dealing with this costly dilemma.
Bring the Patient Into the Office
William B. Rogers, MD, a pediatrician in Akron, OH, has a policy that the parent and/or patient come in to his office for a prescription. The parent brings the child in, I get the story, and if needed I write a prescription, Rogers tells us. He codes the visit CPT 99211 or 99212. When he uses 99211, the nurse can even take the history, he adds. Its important that the nurse has some face-to-face time with the patients, and that her notes reference any prior phone calls. The nurse can even save time and get the history over the phone before the patient comes in to be seen by the physician, explains Rogers. With 99212, Rogers tells us its usually for about a 10 minute visit with the patient and parent.
Ive never had any trouble getting reimbursed by insurance companies for this process, the pediatrician adds.
Of course, there are parents who object to having to come into the office for a prescription. For example, when the parent believes their child needs an antibiotic, and asks to have it phoned in. I tell them I refuse to phone in a prescription for antibiotics without seeing the child, he says. Some patients also run out of Ritalin and call the doctor to request that a refill be phoned in. I tell them I cannot legally phone a Ritalin refill in without seeing the child, says Rogers, noting that Ritalin is a Schedule II drug, the most restricted category of legal drugs.
For years, Rogers has used 99211 or 99212 for Ritalin refills, with the patient coming in for the prescription. This way I only need to reexamine every three to four months, he says.
Ritalin refills are only for 30 days, and at the end there needs to be some information obtained about whether the medication is working, and whether there are side effects. Those two questions can be answered over the telephone, which is how most offices do it, states Joel Bradley, Jr, MD, FAAP, a member of the AAPs RBRVS committee. The telephone is the most efficient way to get that information, although it doesnt improve your overhead.
Bradley, who practices in Clarksville, TN, says the key question is whether seeing a patient to refill a prescription enhances quality of care. If it does, then you should go ahead and do it, and code accordingly (92111 if a nurse sees [...]
