For successful reporting under the 2010 e-prescribing incentive program, a single quality-data code (e-prescribing G-code) should be reported, according to the following coding and reporting principle:
- G8553: At least one electronic prescription created during the encounter was generated and transmitted electronically using a qualified e-prescribing system.
- Deleted from 2009 numerator coding: G8443; G8445; G8446
Current requirement: Participants must report the e-prescribing measure at least 25 times during the 2010 reporting period: Jan. 1 to Dec. 31.
The reporting threshold takes into consideration the fact that prescriptions are not generated with every patient encounter and that some prescriptions cannot be billed electronically. The e-prescribing incentive will again be 2 percent of the total estimated allowable charges for all professional services furnished during the reporting period. In order to qualify for the incentive, 10 percent of the physician’s billing must come from E&M or eye codes. Currently, ophthalmology’s only option to qualify for the program is claims-based reporting.
An April 2009 Academy survey showed that 43 percent of members were participating in the 2009 incentive program. For additional information, visit www.aao.org/e-rx.
Typical Enrollment Processing Days
Medicare payers are reporting 28 days to process an initial application, 22 days for changes of information and 21 days for reassignments. Using PECOS Web is averaging 12 days.
Typical Redetermination Processing Days
Medicare payers are reporting a minimum of 51 days to redetermine a claim once all pertinent information has been received.
Corneal Tissue: Claim Submission for Processing, Preserving and Transporting
Invoices must be submitted with claims for HCPCS code V2785 (processing, preserving and transporting of corneal tissue) in order for payers to determine the appropriate payment. Payment is based on the lesser of the billed amount and invoice amount. Charges for shipping and handling are not typically covered.
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About the author: This article was written by AAOE coding executive Sue Vicchrilli, COT, OCS. It originally appeared in the AAOE August 2009 Coding Bulletin.