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General

Author:
Codapedia Editor
e-Prescribing UPDATE from CMS Final Rule for Jan 1 2010
Citations: Medicare's information page, Clinician's Guide to e-Prescribing, Medicare's 11 page summary,
Resources: Medicare e-prescribing Specifications (pdf)   CMS 2010 e-prescribing notes (pdf)  
Total Reviews: 8
Current Rating: •••••••••

CMS released its Physician Final Rule 10-30-09!  They made e-prescribing easier.

Starting Jan 1 2010,  physicians can show that they have and are using a qualified e-Prescribing program by reporting on 25 claims only, (per eligible professional, not per practice) for the entire year.  In addition, there is only one code that will be reported, (on a claims basis, with the appropriate office based service described below) G8553.  G8553 indicates that the physician or other eligible professional has a qualified e-Prescribing program, and used it to provide at least one prescription at this visit.  CMS reasons that if a physician has a program, and changes their work processes, then there is no added benefit to reporting on the additional changes.

G8553 is a code change from 2009--many thanks to the commenter who found this on the CMS website and posted the clarification.  

e-Prescribing is:

•    Medicare initiative to encourage physicians to use electronic methods to submit prescriptions to pharmacies.
•    Physicians who use a qualified e-Prescribing program are eligible for a 2% bonus of Medicare allowances for 2009
•    Using an e-Prescribing program starts as an incentive—not using one becomes a penalty!
•    Claims based program.  Report G-codes with $0.00 value with an E/M service, any diagnosis

Bonus/incentive payment for successfully reporting on claims for each year:
Bonus    Year
2%        2009
2%        2010
1%        2011
1%        2012
0.5%     2013
Penalty    Year
1%         2012
1.5%      2013
2%        2014

Qualified e-prescribing program
Documents whether provider has adopted a qualified e-prescribing system and the extent of use in the ambulatory setting. To qualify this system must be capable of ALL of the following:
•    Generating a complete active medication list incorporating electronic data received from applicable pharmacy drug plan(s) if available
•    Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks
•    Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any)
•    Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements
received electronically from the patient’s drug plan

For 2010: report on 25 claims per eligible professional:

G8553:At least one prescription created during the encounter was generated and 

transmitted electronically using a qualified eRx system 

For 2009: 
Report on 50% of claims for
a new patient visit, an established patient visit or office or outpatient consult: (99201-99205, 99211-99215, 99241—99245).  Also report on these eye codes: (92002, 92004, 92012, 92014)  and these psych codes (90801, 90802, 90804, 90805, 90806, 90807, 90808, 90909) these health anc behavioral assessment codes: 96150. 96151, 96152) and the screening pelvic and breast exam (G0101) and diabetes outpatient self management codes: (G0108, G0109).   At least 10% of all revenue must be from these codes to be eligible.  Only report on these services, not on hospital services, procedures, labs, etc.  Only these specific codes.

G8443: All prescriptions created during the encounter were generated using a qualified e-Prescribing system
G8445: No prescriptions were generated during the encounter. Provider does have access to a qualified e-Prescribing system
G8446: Some or all prescriptions generated during the encounter were handwritten or phoned in due to one of the following: required by state law, patient request, or qualified e-Prescribing system being temporarily inoperable

 

There are no specific diagnosis codes required.

Printable Version

Related Articles
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  • Is the PQRI bonus based only on the charges with measures?
  • Quality Data Codes and diagnosis listing
  • What are PQRI numerators and denominators?
  • Why did so few physicians receive a PQRI bonus in 2007
  • Do all physicians in a group need to use the same PQRI measures
  • Do all physicians in a group need to participate in PQRI
  • Where are the PQRI worksheets

  • Click Here to Comment, Clarify and Rate this Article

    derinda
    Tue, Apr/05/2011
    G8553
    Is G8553 the code for E-Prescribing? What about G8443, G8445 and G8446?

    Savonna
    Thu, Jan/07/2010
    Ratings: •••••
    G8553
    Started eprescribing with 2 of the 6 physicians here in December of 2009. I am now currently eprescribing with all physicians. However I was wondering your opinion on the code change. 2009 codes allowed you to bill G-code if you saw the patient and had an eprescribing system but did not use for certain reasons as well as saw the patient had a system but did not prescribe any medications. G8553 does not address these types of issues. Does that mean that 2010 rules are that you must send prescription using eprescribing system? If so it seems that my Pain Management physician will not make the 2% for this year and in years to come be penalized because all of his prescriptions are narcotics.. Any ideas on the issues above?

    asinger2077
    Tue, Dec/01/2009
    Penalty Dates
    I have a question about the incentive payment years and the penalty payment years. You list incentive payments for 2012-2013 and penalty payments starting in 2012-2014. It seems strange that CMS would pay extra for using eRx AND penalize for not using in 2012 - the same year. Usually they make reporting required the same year they start reductions for NOT using. Can you verify the dates for the years the penalties start? Thank you!

    Codapedia Editor
    Wed, Nov/25/2009
    G8553
    THank you for the update! I'll modify the article right away!

    joycematola
    Wed, Nov/25/2009
    Ratings: ••••
    G8553 for 2010 eRx reporting
    According to the CMS website 2010 eRx Measure Specification, the code to report is G8553 at least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system.

    Codapedia Editor
    Wed, Nov/25/2009
    25 notes/eligible professional
    The requirement is per eligible professional (that is NPI) not per group.

    LindaLou
    Wed, Nov/25/2009
    Ratings: ••••
    25 per year
    Do we know is this 25 per physician or 25 per practice (tax ID)?

    bwehde
    Tue, Aug/18/2009
    Ratings: •••••
    Asst office mgr
    This will be an important ruling to watch. It will eliminate billing these codes all year long. I agree that if a doctor has the system in place, why make us code all year long to prove it! Thank you!

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