Dear John: Psychiatric Medication Management
Have a Coding Quandary? Ask John
Q: Which evaluation and management (E/M) codes should be billed for patients seen in either a free-standing post-acute brain injury rehabilitation facility or a free-standing residential brain injury rehabilitation facility? The physician would be visiting the patient for psychiatric medication management.
A: In years past, CPT® included a code for medication management (90862), but that code is no longer active. CPT® instead includes an add-on code for “pharmacologic management” when performed with psychotherapy services (+90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure)); however, that code doesn’t fit in this case because psychotherapy is not performed.
For the medication management described, the best choice is the standard E/M codes for a new or established patient. In the outpatient setting, the codes are 99201-99215.
The American Psychiatric Association (APA) advises, in its “Frequently Asked Questions: 2013 CPT Coding Changes:”
Question: In my outpatient practice I often see patients for medication management and previously used CPT® code 90862, which was deleted for 2013. What code will I use in place of 90862?
Answer: The typical outpatient 90862 is most similar to E/M code 99213. If the patient you are seeing is stable, and really just needs a prescription refill, code 99212 might be a more appropriate crosswalk. If you have a patient with a very complex situation, you might need to use 99214, a higher level E/M code. The E/M codes have documentation guidelines published by the Centers for Medicare and Medicaid Services (CMS) that explain how to determine which level code to choose. There is a link to this information at http://psychiatry.org/cptcodingchanges.
The APA further advises in “Changes to Psychiatry CPT Codes” that to determine the E/M service level, “The 1997 [E/M documentation] guidelines are the most appropriate ones for psychiatrists to use since they include a single-system psychiatric exam.”
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