Navigating Reporting and Coding Solutions for Pharmacist Integration in New Care Delivery Systems

Workshop Description:

The purposes of this workshop are to provide the AAPC coding community with an overview of pharmacists’ patient care roles and responsibilities in evolving healthcare delivery systems and to present case study examples of successful health reporting and billing solutions.

Learning Objectives:

Upon completion of this Workshop, participants will be able to:

• Describe the evolution of pharmacists’ patient care responsibilities from dispensing medications to assuming responsibilities for patients’ drug therapy outcomes.
• Understand health reporting nomenclature for pharmacists’ professional services.
• Discuss challenges and success in coding pharmacists’ patient care services, and in obtaining reimbursement for these services.
• Apply lessons learned from pharmacist/coding exemplars who have successfully navigated pharmacists’ services coding and billing systems in commercial payer and state government programs.

Workshop Content:

• Overview of pharmacists’ evolving professional responsibilities.
• Historical perspective of pharmacists’ exclusion from the list of healthcare providers eligible to submit claims to Medicare for Part B professional services.
• Summary of literature on the clinical, economic, and humanistic outcomes of pharmacist integration in high-performing healthcare delivery and financing systems.
• Description of the service using official health reporting nomenclature of CPT -Medication Therapy Management Services, including the development of a profession-wide consensus on the pharmacists’ patient care process.
• Overview of pharmacists’ clinical documentation.
• Review of national and state reimbursement requirements for pharmacists’ professional services in both government and commercial payer programs.