Medicare E-prescribing Bonus Payment – Coding Scenario Examples
Example for G8443; All Medications Prescribed Electronically
Mr. Johnson sees Dr. Smith regularly for treatment of his hypertension and hyperlipidemia. Dr. Smith e-prescribes the renewal of Mr. Johnson’s medication. Dr. Smith bills CPT code 99214 for the established patient office visit and reports the HCPCS code G8443 to indicate that all prescriptions generated during the visit were electronically prescribed. Dr. Smith lists ICD-9 code 401.1 to indicate Mr. Johnson’s benign hypertension as the primary reason for the encounter.
Example for G8445, No Medications Prescribed
Mrs. Jones, who is new to Medicare, comes to see Dr. Smith because of her acute, mild respiratory symptoms. Dr. Smith determines that Mrs. Jones has a cold and recommends an over the counter medication. Dr. Smith bills CPT code 99202 for the new patient office visit and reports the HCPCS code G8445 to indicate that there were no prescriptions associated with the visit. Dr. Smith lists ICD-9 code 460, acute nasopharyngitis, as the reason for the encounter.
Example for G8446, One or More of Medications Not Prescribed Electronically
Mrs. Green, who regularly visits Dr. Smith for multiple chronic conditions, sees Dr.Smith for extreme pain associated with her severe arthritis that is compounded by her osteoporosis. Dr. Smith prescribes a controlled substance, which cannot be prescribed electronically, for her pain in addition to renewing other prescriptions. Dr. Smith bills CPT code 99215 for the established patient office visit and reports the HCPCS code G8446 to indicate that one or more of medications were not e-prescribed. Dr. Smith lists ICD-9 code 715.09 to indicate Mrs. Green’s generalized osteoarthritis in multiple sites is the primary reason for the encounter.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Procedure code and description 95806 - Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory air...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...