Wiki Billing 90862 with E/M code

[msbilling85]

I have a family practice client that would like to add 90862 (med check) to their EM visits. From what I have read, this is inappropriate billing. Unless they are only coming in for med checks (for ADD or depression), is the only time you can bill this. I feel that this would be included in the office visit. I would like input on this or where I can get it in "black and white" so I can show the physicians the proper way to do this.

Thank you!

 

[thompsonsyl]

Hi,

I just looked up the codes you mention and they are considered mutually exclusive and the indicator on the CCI Edits list is "O". I don't know if the link below will work for you but if not, you can log on to the the CCI Edits via the CMS website.

Hope this helps!

http://www.cms.hhs.gov/NationalCorr...r=ascending&itemID=CMS046545&intNumPerPage=10

 

[kevbshields]

Although CCI Edits will get you a general idea, my comments won't be "black and white" either.

CPT conventions include the service of 90862 in an E/M. Take an audit sheet for E/M and show your physician the Risk Table--Prescription Meds are included there, so it's a "bundled" service.

What your physicians are "wanting" to do is unbundling, and there's plenty of commentary around on that practice.

Good luck.

 

[msbilling85]

Thanks everyone for your input. It has sent me in the direction I knew I needed to go!