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90862 vs 99214

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1073358

Expert
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454
Location
Merrill, WI
When you are auditing a psych chart, how do you differentiate between 90862 and EM codes?give me examples please. I know its whatever the focus of service is, but when reading the notes, its not always that simple.
 
90862 - patient already on meds, presenting for follow up. Focused MS exam. No side effects, no med adjustments necessary. Average visit between 10 - 15 minutes.

99214 - patient presents to start meds.
Full MS exam, labs possible. Inital meds started with request for follow up in most cases.

Patient on meds presents regarding side effects, needs medication adjustment, etc.
More than minimal evaluation

:)
 
Last edited:
90862 vs 99212

The 90862 does not state face-to-face. As an FQHC, our local Medicaid office is telling us that 90862 is not valid as an FQHC service due to this. However, they further state that if we have H&P, face to face, and documented exam, then it meets the criteria.

I would consider this 99212 or 99213 based on how much history and medical decision making is involved.

What would you consider?
 
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