In this article, we will focus on the use of “incident-to” billing codes for MTM in conjunction with a physician visit.
Through the use of incident-to CPT billing codes, physicians can bill for pharmacist-led medication counselling sessions. This practice is common in specialty practices, but is now trickling down into the family practice physician’s clinic.
The incident-to codes 99211-99215 allow for the physician to bill based on the complexity of the issue and the time spent with the patient. Here is a link that explains the differences in time and complexity of the coding system. This should be used as a guide for providing basic incident-to MTM counselling.
The American Academy of Family Physicians estimates that “only five 99211 encounters with Medicare patients in a week will result in over $5,000 per year for a practice”.
The basic guidelines for using these codes include: the patient must be established with the provider’s office, the encounter must be face-to-face and an E/M service must be provided separate from the physician encounter. More information about benefits and good examples can be found in AAFP’s article which can be accessed here.
In Part 3 we will discuss how clinical pharmacists can offer pharmacogenomic testing as part of their service offerings.
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