Primary Care Coding Alert

Answer: If the patient’s only reason for visiting the office was to refill a prescription, and there was no face-to-face service provided by the physician or other qualified healthcare professional (QHP), there would be no service to bill. In fact, billing in this scenario would be considered upcoding, which is illegal under the Federal False Claims Act (FCA).

However, your practice might be able to bill under the following circumstance:

• If the patient also had questions about the treatment/ prescription
• If there were forms to fill out, which is sometimes the case for some conditions, such as attention-deficit/ hyperactivity disorder (ADHD) medications because many of them are controlled substances

In cases such as these, you’d probably use the ICD-10 code Z76.0 (Encounter for issue of repeat prescription) if appropriate, and CPT^® code 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional.). This approach assumes that the treating physician or other QHP is not present at the encounter and a member of the provider’s clinical staff is working with the patient on resolving the patient’s issues by providing some assessment and management of the patient.