CMS Changes E-Prescribing Codes for 2010

The Centers for Medicare and Medicaid Services made it easier this year to collect a bonus for Electronic Prescribing. For certain ambulatory services, CMS now requires only one “G” measure code to be submitted on a claim. The measure is required to be reported on only 25 claims for the reporting period to be eligible for the 2% bonus. This is much easier than last year, when CMS required that one of three measure codes be submitted on 50% of eligible claims.

The new 2010 measure code is G8553 – At least one prescription created during the encounter was generated and transmitted electronically using a qualified eRx system. As in past years, the code should be submitted with a $0.00 charge amount. A prescription faxed to a pharmacy is not considered e-Prescribed.  CMS requires that at least 10% of the practitioner’s TOTAL Medicare Part B allowed charges be one of the denominator codes.

The denominator codes were also revised and now include pharmacologic management, nursing facility, assisted living and home evaluation/management services. These services are in addition to office E/M services, ophthalmologic examinations, health/behavior interventions and certain psychiatric services. The consultation codes were deleted from the measure.

This measure can be reported through either claims-based or registry-based options. A listing of registries is available on CMS’ website. A provider can also report the measure through a qualified electronic medical record.

The following defines CMS’ meaning of a qualified eRx system. The system must be capable to do all of the following:

• Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available.
• Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts.
• Provide information related to lower cost, therapeutically appropriate alternatives (if any). (The availability of an eRx system to receive tiered formulary information, if available, would meet this requirement for 2010.)
• Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan (if available).

Written by: Marianne Russo, CPC, CMC