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When You Can Bill 99605 for Rx Refills (and 4 Times You Can’t)

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When You Can Bill 99605 for Rx Refills (and 4 Times You Can’t)

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Medication management

When patients need new or updated prescriptions, your provider probably puts a lot of work into ensuring that they get the right medications. In these situations, there may be occasions when you can bring in reimbursement for medication management using codes 99605-99607. Find out when this is an option and when it isn’t.

When You Can Report Medication Management

If the doctor performs medication management, you might be able to report 99605, 99606 or 99607 for that service, assuming it’s medically necessary and thoroughly documented. To justify this, you must document the following details.

Why It Was Performed: This may entail the provider ensuring that the patient is taking their medicine correctly, taking the right dosage at the right time during the day, not taking too much, and isn’t taking anything that should be discontinued or swapped out. The provider may also look for any contraindications and ensure that the patient is adhering to medication safety standards.

What Prescription Was Written: The documentation should include information about the prescription written at the appointment. Is it new? Is it a dosage change? Is it to be taken at a different time of day?

Why Changes Were Made: If the provider added or removed a prescription, changed a dosage or made any other adjustments, the documentation should explain why.

What Doesn’t Constitute Medication Management

Although most payers allow you to report an E/M visit and medication management together on the same date of service, both pieces of documentation must be able to stand on their own to justify reporting both services. In many cases, the documentation supports an E/M or a medication management visit, but not both.

For instance, suppose a patient presents to your practice for a six-month check-up for his diabetes. The provider evaluates the patient, performs a medically necessary E/M service, and at the end, calls in an extension of a patient’s medication to the pharmacy. In this case, your provider hasn’t performed any separately billable medication management services, so you should report the E/M code, and the prescription refill will be bundled into that.

Here are some other situations when you can’t report medication management.

When the provider simply lists the patient’s current medications. This is typically done at every E/M visits, but it isn’t considered medication management.

When the provider administers an injection. Just because you’re giving a patient medication at the visit doesn’t mean you’re performing a medication management visit.

When you monitor a patient following an injection. Checking to make sure a patient doesn’t have an adverse reaction to a medication does not constitute medication management. It’s instead bundled into the charge for the injection visit.

By getting a thorough understanding of what medication management entails, you’ll know when you’re reporting 99605-99607 accurately and when you aren’t.

Seeking more information about when and how to bill for prescription refills? Listen in as healthcare attorney Amanda Waesch, Esq., walks you through every step of collecting for these visits during her 60-minute training event, Charge Patients Extra for Prescription Refills. Sign up today!

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