Wiki 90862 - Patient does not take psychotropics

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heatherwinters

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A patient came in for an initial eval with psychiatrist and sees our counselor. Patient came back to see psychiatrist on 10/09/09. Length of visit was 15 minutes. Modality of treatment was medication management checked. However, no psychotropics were managed or documented. If a patient is only evaluated as to whether or not they should take psychotropics, you cant bill a 90862 can you?

From what I understand the following is a 90862
The following must be documented to justify the medical necessity and use of 90862:

• Diagnosis of the patient
• Evaluation of disease process
• Medication prescribed
• Rationale for the changes in drug therapy, expected response
• Order and/or review of laboratory tests as appropriate
• Patient allergies as appropriate
• Any minimal supportive psychotherapy
• Patient education of potential risks, side effects and benefits

If there is no CC: on the note, I have vitals, documentation of symptom checklist, no exam just a session synopsis, a plan to return in 2 months, icd-9 dx.

How would you code? Ask for documentation of CC: then bill 99212? The session wasnt long enough to bill as psychotherapy code.

Thanks
Heather
 
Although you are correct in your thoughts on the use of the code, I think I would still go ahead and use the 90862 in this case. The intent is a med mnmgt eval. Since the intent of visit is usually the driving factor, and he is evaluating for that drug use, I would say bill it.
 
You're options are limited here. I agree with 90862; certainly the intent is met, especially if we justified why the psychotropics are contraindicated. From procedural narrative and CDR for CPT, if the patient is receiving "Psychiatric" services and the intent is for pharm. management the code can be used. I hope this helps.
 
90862

We are billing 90862 as inpt the payer is denying this code for outpatient code. Does anyone know if this code can be used as an in patient?

Thank you

William Karr, CPC
 
Last edited:
wkarr said:
We are billing 90862 as inpt the payer is denying this code for outpatient code. Does anyone know if this code can be used as an in patient?

Thank you

William Karr, CPC
Click to expand...

I had tried to bill inpatient as well, and all of mine got denied, so I am thinking it is outpatient only
 
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