Oncology & Hematology Coding Alert

Question: Is there a code I can report when a patient just comes in to pick up a prescription?


Arizona Subscriber
Answer: In short, no. CPT specifically includes writing prescriptions as part of an E/M service. Your office should consider prescription writing as part of the cost of seeing patients.

What to do: If the oncologist or a nurse sees the patient for a medically necessary reason, you should report the appropriate E/M code -- for example, an established patient code (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...). 

But don't report an E/M if the patient comes to your office just to pick up a prescription and neither an oncologist nor a nonphysician practitioner sees her for a medically necessary reason.

Note: The prescription service, if documented, may accrue to the medical decision-making of a subsequent E/M service.

Caution: Don't be tempted to report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...) simply because a nurse -sees- the patient picking up the prescription. Code 99211 is not the -nurse visit- or -catchall- code that so many practices assume it to be. You must meet all the requirements for 99211 before you report it.

Diagnosis option: There is a diagnosis code that might be appropriate for you to report for prescription pick-up -- V68.1 (Issue of repeat prescriptions). You should use V codes to provide additional clinical information to an insurer, whether it's Medicare or a private carrier. 
 
The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders National Advisory Board.