DX code for DME billing

[SCRph2014]

Question for the crowd -- For billing Medicare Part B, does the MD have to write the diagnosis code on the script or can the pharmacy add it after consulting with the doctor's office? We have an RX to bill and my partner/PIC says "The doctor HAS to write the dx codes on the original RXs and per Part B the pharmacy cannot add them." in reference to a prescription we received where the doctor write "Diagnosis: Type II diabetes with nephropathy" rather than putting the ICD-10 code. I don't recall ever hearing this, but the world of Medicare B is a mysterious one. Anyone have any input?

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[owlegrad]

Your partner is correct. Part B billing is it’s own beast and as far as I can recall EVERYTHING has to be on the script, the pharmacist cannot add, modify, or clarify any portion of it. And obviously forget about getting a verbal.

 

[SCRph2014]

Your partner is correct. Part B billing is it’s own beast and as far as I can recall EVERYTHING has to be on the script, the pharmacist cannot add, modify, or clarify any portion of it. And obviously forget about getting a verbal.

Thank you! Seems so silly in the current day and age of medicine, Medicare billing is archaic. I guess I haven't run into this situation in the last 6 years of being a pharmacist (lucky me!) and I must be confusing the clarifications with what we can add to CII RXs

 

[owlegrad]

Thank you! Seems so silly in the current day and age of medicine, Medicare billing is archaic. I guess I haven't run into this situation in the last 6 years of being a pharmacist (lucky me!) and I must be confusing the clarifications with what we can add to CII RXs

Well I don’t want to make it a habit to defend Part B but I think the idea was to cut down on fraud so they REALLY cracked down on what they would allow and verbals were something they decided to target. Considering how prevalent fraud is I can’t really blame them.

 

[angelsplight]

Yup, everything has to be on the script. I remember making a call to medicare because a script kept getting rejected for billing and they told me that the diagnosis code, the date of the patient visit to the doctor, a specific minimum number of refills and quantity for it to go through. I found that to be the single most idiotic thing ever and even the doctor on the other end was like...are you kidding?

 

[deleted945127]

The most annoying part to me that it needs to have 2 dates ...one for rx and one for the dr signature if it was hard copy rx.
Another reason why i like escribe rx

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[MilknCheerios]

Having the dx code on the RX is the most secure way to ensure that the Medicare B department will accept it. However, I swear I've submitted Rxs in the past with just the DX code annotated on it and they've still gone through. Then, in the future, if there is a chargeback, a form is sent to the doctor proving the diagnosis codes are correct and everything is good (ie: albuterol solutions-- don't know about DME though).

Ultimately, Medicare B billing is time consuming, reimburses poorly, and has so many hoops to jump through that I wish they just did away with it.