90862 & adhd


Tyler, Texas
Best answers
My physician attended a conference in which a physician told all the pediatricians in his class that it is OK and recommended to bill a 90862 for ADHD med refills when the parent presents to pick up the prescription. We have a questionnaire each parent fills out at that time but I am new to pediatric billing and wondering if anyone can help me and tell me if this is truly ok.

Thanks in advance for any help you can give me
Since 90862 is a psyciatric CPT code, I would try to find out if they are limited to psychiatrists only with a few payors before I billed them. I found a few sources for information for documentation requirements that are helpful in protecting your physician in case of an audit by MCR or a commercial payor.

Source #1:
CPT code 90862, Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy:
Please refer to the appropriate CPT code book for the date of services provided. This code is not intended to be used for the actual administration of medication, nor is it intended to be used for observation of the patient taking an oral medication. Administration and supply of oral medication is a non-covered service. Nor is it intended to refer to a brief evaluation of the patientÕs status or simple dosage adjustment of long term medication. The code refers to the in-depth management of psychopharmacologic agents which are potent medications with frequent serious side effects, and represents a very skilled aspect of patient care.

Source #2:

Hope that helps.