Primary Care Coding Alert

Medicare adds pharmacologic management edits If you report 90862, you'll need to know which hospital and nursing home facility codes you can use for prescription management with an E/M service. Don't Bill 90862 With 7 Hospital Services The latest version (9.3) of the National Correct Coding Initiative (NCCI) bundles medication management code 90862 (Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy) with numerous outpatient, inpatient and nursing home facility codes. Medicare clarifies that you shouldn't code for pharmacologic management (90862) with certain facility services, such as emergency department (ED) visits (99281-99285, Emergency department visit for the evaluation and management of a patient ...) and nursing home discharge (99315-99316, Nursing facility discharge day management ...).

The edit shouldn't shock you, says Heather Yatsko, office coordinator at Hanover Health Corporation in Hanover, Pa. "Writing prescriptions is part of the patient's care that the physician includes in the E/M service," she says.
Generally, you would report 90862 when your FP provides no other E/M service at that encounter. "So, these bundles shouldn't affect your billing," Yatsko says. NCCI now includes 90862 with 10 services, in addition to 99281-99285 and 99315-99316:

99217 - Observation care discharge day management ...
99218-99220 - Initial observation care, per day, for the evaluation and management of a patient ...
99293-99294 - ... pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child ...
99295-99296 - ... neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less
99298-99299 - Subsequent intensive care, per day, for the evaluation and management of the recovering ... infant. Here's how the edits affect observation coding: After passing out during an anxiety attack, a Medicare patient who is taking venlafaxine HCl presents to the ED. The ED physician asks the patient's FP to assume care. The FP admits the patient to observation, evaluates the medication's effect on the patient, determines that the patient requires a higher dose and writes a prescription until the patient's next scheduled appointment. Because Medicare bundles 90862 with 99218-99220, you should report the E/M service only (99218-99220).