Proposed Point-Based Billing Procedure Document for Clinical Pharmacy Services Billing Incident-to Physician 1 Point each 2 Points each 3 Points each 4 Points each 5 Points each ☐ ☐ ☐ ☐ ☐ Review 1 Review 2 Review 3 Review 4 Patient problem* problems* problems* problems* education >20 minutes# ☐ ☐ ☐ ☐ ☐ Patient Patient Patient Patient Start insulin education <5 education education education minutes# between 5−10 between 11−15 between 16−20 minutes# minutes# minutes# ☐ ☐ ☐ Visual foot Manual BP Comprehensive inspection check foot inspection ☐ ☐ ☐ Review Change Order new labs relevant labs medication dose ☐ ☐ Refill Start new medications medication and/or supplies ☐ New patient *Problems refer to those diseases authorized to be managed by the clinical pharmacy specialist (CPS) in the Collaborative Drug Therapy Management (CDTM) protocol (i.e., DM, HTN, dyslipidemia, and/or tobacco cessation). #Education time based on standard 30-minute appointments. Billing Level: 99211 = 1−5 points 99212 = 6−10 points 99213 = 11−15 points 99214 = 16−20 points 99215 = >20 points Guidelines for Point-Based Billing: The patient education time parameters (i.e., 5−10 minutes for 99212, 11−15 minutes for 99213, etc.) are based roughly on the CPT codes (listed below) for physician billing based on face-to-face time spent with patients. Based on this point system, most follow-up visits would be billed at a 99212 level. Most new patient visits would be billed at a 99213 level. Brief patient encounters would be billed at a 99211 level. Physician Schema for billing 99211-99215 (copied from CPT Manual 2009)
Proposed Point-Based Billing Procedure Document for Clinical Pharmacy Services Billing Incident-to Physician 1 Point each 2 Points each 3 Points each 4 Points each 5 Points each ☐ Review 1 problem* ☐ Review 2 problems* ☐ Review 3 problems* ☐ Review 4 problems* ☐ Patient education >20 minutes# ☐ Patient education <5 minutes# ☐ Patient education between 5−10 minutes# ☐ Patient education between 11−15 minutes# ☐ Patient education between 16−20 minutes# ☐ Start insulin ☐ Visual foot inspection ☐ Manual BP check ☐ Comprehensive foot inspection ☐ Review relevant labs ☐ Change medication dose ☐ Order new labs ☐ Refill medications and/or supplies ☐ Start new medication ☐ New patient *Problems refer to those diseases authorized to be managed by the clinical pharmacy specialist (CPS) in the Collaborative Drug Therapy Management (CDTM) protocol (i.e., DM, HTN, dyslipidemia, and/or tobacco cessation). #Education time based on standard 30-minute appointments. Billing Level: 99211 = 1−5 points 99212 = 6−10 points 99213 = 11−15 points 99214 = 16−20 points 99215 = >20 points Guidelines for Point-Based Billing: The patient education time parameters (i.e., 5−10 minutes for 99212, 11−15 minutes for 99213, etc.) are based roughly on the CPT codes (listed below) for physician billing based on face-to-face time spent with patients. Based on this point system, most follow-up visits would be billed at a 99212 level. Most new patient visits would be billed at a 99213 level. Brief patient encounters would be billed at a 99211 level. Physician Schema for billing 99211-99215 (copied from CPT Manual 2009)
Proposed%20Points-based%20Billing%20Procedure%20for%20clinical%20pharmacy%20services%20billing%20incident-to%20physician.docx