Pediatric Coding Alert

Pediatricians and their staff are spending more and more time on the phone calling in prescriptions. And some practices are wondering if there is any way they can be reimbursed for this. The good news is, there is: You can bill the parents. Heres how one practice has solved the problem.

Routine refills: These are for medications that are taken daily and for long periods of time (for example, seizure medications), or taken for short intervals but only if the problem flares up (for example, medications for recurrent herpes infections). The practice will phone in those refills within 24 hours with no charge Mondays through Fridays, with the exception of holidays. On weekends or holidays, however, there will be a $10 charge for phoning in these prescriptions. If a parent cannot wait 24 hours and needs a routine refill immediately prior to the close of that days office hours there also will be a $10 charge to the parents.

New medications: In recognition of the fact that many medical problems can be managed over the telephone (such as a cough, congestion, head lice or thrush), with perhaps the additional phoning in of a prescription, the practice is instituting two levels of charges. The charge will be $5 if the prescription is resulting from simple or straightforward medical problems that require a basic level of decision-making, the practice policy states (head lice or thrush are examples of basic decision-making). The charge will be $10 for prescriptions that result from a higher degree of decision-making, according to the policy, which notes that this would include problems that are somewhat complicated, require careful or prolonged discussion with a physician, or that result from an extended discussion with consultants or other physicians (adjusting a Ritalin dose is an example of higher-level decision-making). In its policy, which is given to parents, the practice notes that this kind of management (prescribing for a new illness by telephone) is necessitated by the fact that so many parents are both working, making it difficult for anyone to bring the child in for a regular office visit.

Finally, the policy notes that phoning in prescriptions is not covered by managed-care plans or by Medicaid. The five-fold increase in the charge we incur from our answering service is cited as the main reason for the change.

What are parents likely to think of such a policy? At first, they may be concerned and upset, says Richard H. Tuck, MD, FAAP, a pediatrician and coding expert who is on the American Academy of Pediatrics Coding and Reimbursement Committee, of which he was founding chairman. They think [...]