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Thread: Billing 90862 with E/M code

  1. #1

    Default Billing 90862 with E/M code

    AAPC: Back to School
    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!

  2. #2
    Join Date
    Apr 2007
    San Diego



    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!

    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  3. #3
    Join Date
    Apr 2007
    Louisville, KY


    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.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  4. #4


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

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