Dear John: Psychiatric Medication Management

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. 

—California Physician

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A: In years past, CPT® included a code for medication management (90862), but that code is no longer active.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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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 402 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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