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Thread: Med Refill

  1. #1

    Default Med Refill

    AAPC: Back to School
    I have a question regarding medication refills that have come up at our clinic that I hope someone can provide further clarifacation on please......

    If a patient calls the clinic and speaks to the nurse on the phone in order to have a medication refill, is this codable? I say no way, but the nurses I have since learned have been noting this with the telephone services CPT codes. They feel that since they had a phone conversation with the patient and it does not always refer back to an E/M service within the previous seven days as the telephone service code guidelines say, they can use this code. I say that this is a non-codable, non-billible thing?

    What about if the patient comes into the office for a med refill and only sees the nurse. Would this be 99211? I know that if they patient sees the provider for a med refill, we can use an E/M code based on the documented level,but can 99211 be used for a nurse only visit for a med refill?

    Any insight?

    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  2. #2
    Join Date
    Apr 2007
    Loma Linda CA

    Default med refill

    Telephone CPT codes 99441-99443 are strictly for physicians, copy the guidelines for your nursing staff, which is in your CPT book under NON-Face -to face physician services. You are absolutely correct you can not assign the telephone codes or level 99211 - this is all part of the standard of care.


  3. #3


    My thoughts exactly! Thanks so much for the confirmation!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  4. #4


    This question came up in our Group as well. One of our Family Practice Physicians felt he should charge for just about anything he did siting this article. http://www.aafp.org/fpm/20040700/43shou.html

    However it was not our group's practice to do so. Also, after reading the article you can see that there are drawbacks to such a practice. It can be done, but you'd have to weigh the pros and cons.

  5. #5
    Join Date
    Apr 2007
    Woodbridge, VA


    If you go to www.trailblazerhealth.com, you will find a great article called Documentation Requirements for CPT Code 99211. Following Medicare's guidelines, it indicates 99211 should not be used "soley for the writing of prescriptions (new or refill) when no other E/M is necessary or performed." CPT 99211 describes a service that is a face-to-face encounter with a patient consisting of elements of both evaluation and management. Maybe you can print this out for your nursing staff in addition to the guidelines for telephone codes as suggested by mholland. Hope this is helpful.

    Zaida, CPC

  6. #6


    My thnaks to both of you. This helps.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

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