Ob-Gyn Coding Alert

Physicians who adopt e-prescription systems areeligible to earn a bonus of 2 percent of their total Medicare allowed charges. But the rules on how you should report your e-prescribing changed for 2010, so take heed.

2010: CMS issued a new numerator G code with the following descriptor:

• G8553 -- At least one prescription created during the encounter was generated and transmitted electronically using a qualified ERX system. Effective Jan. 1, you'll report an e-prescribing code only when a visit results in an electronic prescription being placed. You'll need to report this code at least 25 times (unique visits) during the reporting period for Medicare to consider you a successful e-prescriber.

Remember: "You have an incentive to report this, but the actual code has a zero charge," says Gina Jarrell, CPC, CPP, senior coder for Jefferson Center for Women's Medical Specialties in Philadelphia.

You also need to be sure that this measure's denominator codes make up 10 percent of the eligible professional's Medicare Part B charges. The denominator codes you'll probably use most often for your ob-gyn practice are office and outpatient E/M codes 99201-99215.

2009: In contrast, you previously reported on 50 percent of applicable cases and had more coding options:

G8443 -- All prescriptions created during the encounter were generated using a qualified E-prescribing system

G8445 -- No prescriptions were generated during the encounter, provider does have access to a qualified E-prescribing system

G8446 -- Provider does have access to a qualified e-prescribing system and some or all of the prescriptions generated during the encounter were printed or phoned in as required by state or federal law or regulations, patient request or pharmacy system being unable to receive electronic transmission; or because they were for narcotics or other controlled substances for narcotics or other controlled substances.

Example: Mary Jane, who has a very large uterine fibroid, sees her gynecologist regarding treatment options. The patient is experiencing heavy periods and is currently anemic, and although surgery will be an option soon, the physician suggests that she begin taking Lupron prior to the surgery date to decrease the bleeding and improve the anemia, as well as temporarily shrinking the fibroid to make surgery easier. Her physician performs a level four established patient office visit and e-prescribes Lupron.

You report the denominator code 99214 (Office or other outpatient visit for the evaluation and management of an established patient ...) and appropriate ICD-9 code, such as 218.0 (Submucous leiomyoma of uterus). But the e-scribe code differs. In 2009, you would have reported G8443, but in 2010, you'll report G8553.

Tip: If 2010 will be your first time participating,contact your local pharmacies to ensure they are ready toreceive your e-prescriptions. "This can be the difference between success and failure," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in New Jersey.

Resources: You can learn more, including all eligible denominator codes, at CMS's E-Prescribing Incentive Program page: www.cms.hhs.gov/ERxIncentive/01_Overview.asp