Medication Refills

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April 17, 2014

Question:  

The physician I work for will often send patients home with two different samples of medication to try to see which works best for them. When the patient calls back to tell the physician which medication has worked, the physician writes the prescription and sends it into the pharmacy. He has been billing a 99211 for this on the day he calls the prescription in for them. Is this correct?

Answer:

No, you may not bill an E&M code for writing a prescription without a face-to-face visit. The activity of writing a prescription related to a condition that was evaluated in the office is included in the Evaluation and Management (e/m) code the physician submitted the day he/she saw the patient in the office regardless of when the prescription is written. Per CPT instructions, pre- and post- non-face-to-face work associated with an encounter was included in the calculation of the total work of typical services. So the e/m reported for the face-to-face encounter you had with the patient includes any work associated with the visit that is done prior to or after the patient is seen and should not be reported as a separate service.

Also, CPT 99211 requires a face-to-face visit. Because this communication took place over the phone, it would not be appropriate to charge 99211. There are non-face-to-face codes for telephone services, but these are typically not covered by third-party payors and would be a patient-pay service. Be aware these telephone services codes also have guidelines about when they can be billed. If the phone call results in a decision to see the patient or was a result of an e/m service that was reported in the previous 7 days or during the postoperative period the phone call is included in the work of that e/m or procedure and is not separately reported.