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What's going on with G8553?

For 2014 the code G8553 has been deleted.

The period to qualify for incentives and avoid penalties in 2014 ended 12/31/2013. As of January 1st, 2014 the G8553 is no longer a valid code and will cause rejections or exclusions.

The reporting period for the E-scribe (eRX) incentive ended on December 31, 2013. The last incentives will be earned in 2013 and the penalties for non-participation will be incurred throughout 2014. The last incentives were earned in 2013.

The G8553 code was used to report the use of an eRX in CMS’s Escribe incentive program. The program is still in effect but the use of G8553 for reporting the services was last valid from June to December 30, 2013. There is no replacement code. The following are some of the CMS rules to avoid the 2014 eRX penalty for program-eligible providers:

• E-scribed using the code G8553 on 25 encounters with specified CPT codes between the months of January and December of 2012.
• E-scribed using the code G8553 on 10 Medicare encounters with any CPT code between January and June 30, 2013.
• Earned a 2012 meaningful use for an EHR incentive program for the first time between January and June 30, 2013
• Adopted a certified EHR and registered for the EHR incentive program between January and June 30, 2013.
• Hardship Exemption requested by June 30, 2013.
• Submitted G6842 to CMS before the reporting period ended to indicate practicing in a rural area, or indicating insufficient pharmacies by reporting G6843, or G8644 having lack of prescribing privileges.

2014 eRx Payment Adjustment

Individual eligible professionals and group practices participating in the eRx Group Practice Reporting Option (GPRO), who are not successful electronic prescribers, will be subject to a 2.0% payment adjustment on their Medicare Part B services provided January 1, 2014 through December 31, 2014.

To avoid the 2014 eRx payment adjustment, individual eligible professionals would have had to have been a successful electronic prescriber in 2012, or will need to report the G8553 code, via claims, for at least 10 billable Medicare Part B PFS services provided January 1, 2013 through June 30, 2013. For review, here is the link for the factsheet titled "2013 eRx Incentive Program and the 2014 Payment Adjustments".

Providers may refer to the following resources for more information about the public rate hearings and approval of expenditures:

• http://srssoft.com/medicare-eprescribing-incentives
• Electronic Prescribing FAQs
• http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/index.html

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Michelle Herbert, CPC is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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