Primary Care Coding Alert

Question: My medical assistant (MA) spends a lot of time completing the paperwork required for patients getting prescriptions through patient assistance programs (PAPs). Does a code exist for this service?

Indiana Subscriber Answer: CPT indicates that you should use 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) for filling out extensive reports, such as accident and injury forms as appropriate. Many PAP programs are quite long and time-consuming to fill out. Therefore, 99080 may be appropriate coding for this service.
Although you can try reporting 99080, insurers probably will not reimburse for the code. If you report 99080 and the carrier rejects the code as a noncovered service, you may bill the patient for the service.
 
Remember that CPT considers 99080 an "adjunct to the basic services rendered," so you would not report it alone. For instance, suppose the family physician sees the patient prior to the MA completing the forms. In this case, you should also report the appropriate E/M service, such as 99212-99215 (Office or other outpatient visit for the E/M of an established patient ...) in addition to 99080.