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.