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90862 - Patient does not take psychotropics

  1. #1
    Default 90862 - Patient does not take psychotropics
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    A patient came in for an initial eval with psychiatrist and sees our counselor. Patient came back to see psychiatrist on 10/09/09. Length of visit was 15 minutes. Modality of treatment was medication management checked. However, no psychotropics were managed or documented. If a patient is only evaluated as to whether or not they should take psychotropics, you cant bill a 90862 can you?

    From what I understand the following is a 90862
    The following must be documented to justify the medical necessity and use of 90862:

    • Diagnosis of the patient
    • Evaluation of disease process
    • Medication prescribed
    • Rationale for the changes in drug therapy, expected response
    • Order and/or review of laboratory tests as appropriate
    • Patient allergies as appropriate
    • Any minimal supportive psychotherapy
    • Patient education of potential risks, side effects and benefits

    If there is no CC: on the note, I have vitals, documentation of symptom checklist, no exam just a session synopsis, a plan to return in 2 months, icd-9 dx.

    How would you code? Ask for documentation of CC: then bill 99212? The session wasnt long enough to bill as psychotherapy code.

    Thanks
    Heather
    Heather Winters, CPC, CFPC

  2. #2
    Default
    Although you are correct in your thoughts on the use of the code, I think I would still go ahead and use the 90862 in this case. The intent is a med mnmgt eval. Since the intent of visit is usually the driving factor, and he is evaluating for that drug use, I would say bill it.

  3. #3
    Location
    Louisville, KY
    Posts
    1,101
    Default
    You're options are limited here. I agree with 90862; certainly the intent is met, especially if we justified why the psychotropics are contraindicated. From procedural narrative and CDR for CPT, if the patient is receiving "Psychiatric" services and the intent is for pharm. management the code can be used. I hope this helps.

  4. #4
    Default Thank you
    Thank you
    Heather Winters, CPC, CFPC

  5. #5
    Default 90862
    We are billing 90862 as inpt the payer is denying this code for outpatient code. Does anyone know if this code can be used as an in patient?

    Thank you

    William Karr, CPC
    Last edited by wkarr; 10-13-2009 at 01:58 PM.

  6. #6
    Default
    Quote Originally Posted by wkarr View Post
    We are billing 90862 as inpt the payer is denying this code for outpatient code. Does anyone know if this code can be used as an in patient?

    Thank you

    William Karr, CPC
    I had tried to bill inpatient as well, and all of mine got denied, so I am thinking it is outpatient only

  7. #7
    Location
    Louisville, KY
    Posts
    1,101
    Default
    I am unaware of any POS restrictions on this code.

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