90862-meds mgt.(HELP)


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Does anyone do mental health coding that could help me with understanding if the 90862 code can be billed just to pick up scripts?

Rather than trying to re-word this article, I'll provide the link. I do code/audit for a Rehabilitation and Pain Mgmt clinic. I "bookmarked" this article awhile back since it was so informative. We have many patients who are prescribed opiates as well as other meds. Maybe you will find this useful.


Here's a Q/A, also~

Pharmacologic management

Q Can you explain the appropriate use of CPT code 90862, "Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy"? Should we use this code when we provide psychiatric counseling with management of medication? Is a psychiatric diagnosis code necessary?

A CPT code 90862 should be submitted when you provide any of the following services:

Medication management for a patient who is in psychotherapy with a nonphysician colleague (e.g. a psychologist),
Effective treatment of a patient's condition with psychotropic drugs alone,
Management of a patient who has an organic type of disorder (e.g., Alzheimer's) primarily with the use of medication.
To submit 90862, the above services should include evaluating how the medication is affecting the patient, determining the proper dosage level, prescribing medication for the patient for the period of time before the patient is seen again, and noting any drug interactions or adverse drug effects. You would typically submit a mental disorders diagnosis code with this service, since it is commonly used in conjunction with treatment of such disorders. However, this code may also be used in conjunction with other diagnoses, such as Alzheimer's disease (331.0) or encounter for therapeutic drug monitoring (V58.83).

Note that if you provide more than minimal psychotherapy at this visit, you should report a code for psychotherapy with E/M services instead, such as 90805. You should not code 90862 in addition to an E/M service, since pharmacologic management is included in the E/M service.

CPT code 90862, Pharmacologic management, including prescription, use, and review of medication
with no more than minimal medical psychotherapy:
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 patients 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.
M0064, A brief office visit for the sole purpose of monitoring or changing drug prescriptions
used in treatment of mental, psychoneurotic, and personality disorders. This HCPCS code
should be used for a lesser level of drug monitoring such as simple dosage adjustment. Based on
the assignment of RVUs, the work involved is similar to CPT code 99212 and usually involves less
than ten minutes of time.
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Can a non mental health provider use the CPT code 90862. I need assistance with this question. In order words can a physician bill for this code.