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Dx code with E-Prescribing "G" Codes for Medicare???

Diane Posted Wed 26th of January, 2011 19:16:37 PM

Should there be a diagnosis code included with the G codes that represent prescriptions sent electronically or not?

i.e. G8443 - Simvastatin - must we include diagnosis code for this medication OR is it okay to bill simply as G8443?

Thank you in advance for your help!

-Rochelle P.,MA for Dr. Diane Combs

SuperCoder Answered Thu 27th of January, 2011 18:01:51 PM

Simvastatin has to be billed with an Dx code. If it is treated for problem related to hypercholesterolemia then Dx is 272.0, or if for Dyslipidemia, then Dx is 272.4

The code G8443 is obsolete from 1/1/2011. If the date of service is after 1/1/2011, the code should be J3490.

Marilyn Answered Thu 27th of January, 2011 20:47:34 PM

My doctor just started e-prescribing. I would bill using G8553 and J3490? What is the fee for this service and reimbursement? Also, do we use the same "G" code for commercial carriers?

SuperCoder Answered Thu 27th of January, 2011 22:31:43 PM

If you are an eligible professional (EP) participating in the 2010 E-Prescribing (eRx) Incentive Program, please check the ‘measure specifications’ at the beginning of each calendar year. The correct HCPCS code for reporting this measure may change each year.

For the 2010 incentive payment, submit HCPCS code G8553
For the 2011 incentive payment, the HCPCS code remains the same: G8553
The 2009 eRx measurement codes have been accepted for processing by the Medicare claims systems. However, in October, a temporary change occurred that led to the rejection of 2009 eRx codes. EPs cannot resubmit claims that may have been rejected with the 2009 eRx measurement codes. Submissions reported using a qualified registry or a qualified electronic health record will not be affected by this situation.

We strongly encourage you to work with your vendor or clearinghouse to ensure that any measure specification changes have been made each year. Current information and requirements are available on the CMS Web site at www.cms.gov/ERXincentive.

If you’ve been reporting G8553 (At least one prescription created during the encounter was generated and transmitted electronically using a qualified ERX system), be sure to give the transmittal a close look. The new e-prescribing language solidifies that for non-controlled substances, “as long as a ‘qualified’ e-prescribing system (per Medicare Part D requirements) is used, a pen and ink copy” of the signed prescription order is not required, Loya says. But physicians can’t e-prescribe controlled substances — for example, addictive pain medications — so CMS requires a pen and ink order for these.

For commercial carriers: Contact your local payor for coverage policy info

Diane Posted Fri 28th of January, 2011 19:09:43 PM

My original question was:

must a diagnosis be included with the "G" code (HCPCS 2011 Incentive Payment for Medicare) OR can we simply bill as is?

-Rochelle P., MA for Diane Combs, MD

Deborah Answered Sat 29th of January, 2011 20:17:38 PM

A dx must be used for the G code. You can use applicable dx from the visit.

SuperCoder Answered Mon 31st of January, 2011 21:08:08 PM

I would like to clarify your doubt regarding the way G8443 was billed earlier: Mr. X sees Dr.YYYY regularly for treatment of his hypertension and hyperlipidemia. Dr. YYYY e-prescribes the renewal of Mr. X’s medication. Dr. YYYY 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. YYYY lists ICD-9 code 401.1 to indicate Mr. X’s benign hypertension as the primary reason for the encounter.

Diane Posted Mon 31st of January, 2011 22:57:14 PM

Thank you very much for all your help & responses!

-Rochelle P., MA for Diane Combs, MD

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