Primary Care Coding Alert

Question: One of our patients has complained that he needs to make an appointment for a checkup simply to get his prescriptions refilled. Is there a way to bill this so that it doesnt reflect a full office visit?

Missouri Subscriber

Answer: If the patient is seen for a nurse visit only to get a prescription refill order and no other services are performed, the encounter may be reported with CPT code 99211 (established patient, office or other outpatient visit). This code is assigned for patient visits that may not require the presence of a physician. Usually only a few minutes are spent performing or supervising these activities.

If the prescription treats a chronic condition, many clinicians recommend that the physician see the patient for a brief visit, during which they take an interval history, check vitals, and examine only the specific system being treated. In this case, 99212 (established patient, office or other outpatient visit) would be most appropriately reported, since this code describes visits where the problem is minor and the physician spends less than 10 minutes with the patient.

If the patient receives the refill during an annual checkup or when other E/M services are provided, it would not be separately reported since the time and effort taken to write a refill order are considered bundled into the E/M service.