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Medication management vs group therapy

  1. #1
    Default Medication management vs group therapy
    Medical Coding Books
    My dr would like to start doing medication management in group setting. The focus will be the medications and how they are working, effects, etc.
    Can I bill this as medication management since that is the focus, even though he wants to do it as a group?

  2. Default
    You mean everyone in the group is on the same meds? Or different meds? Guess it really doesn't make a difference.

    CPT 90853 is for group psychotherapy. Talking about the meds is not psychotherapy. Psychotherapy would be discussing the underlying issue of why the group members are on a RX (ie PTSD, depression)

    CPT 90862 is an individual service (RX mgmt with minimal therapy) and can't be coded for group services.

    90862 is not simply "renew my perscription". Here is a paste of expected documentation for 90862. It would seem to be such a violatiion of confidentiality if each patient had to answer all this or be assessed by the provider in a group setting

    Documentation of medical necessity for pharmacological management (procedure code 90862) must address all of the following information in the patient's medical record in legible format:
    • Date and time
    • Diagnosis โ€“ update at least annually
    • Interim Medication history
    • Current symptoms and problems that include any physical symptoms
    • Problems, reactions, and side effects, if any, to medications and/or ECT
    • Current Mental Status Exam
    • Any medication modifications
    • The reasons for medication adjustments/changes or continuation
    • Desired therapeutic drug levels, if applicable
    • Current laboratory values, if applicable
    • Anticipated physical and behavioral outcome(s)

  3. #3
    Default
    Quote Originally Posted by sbicknell View Post
    You mean everyone in the group is on the same meds? Or different meds? Guess it really doesn't make a difference.

    CPT 90853 is for group psychotherapy. Talking about the meds is not psychotherapy. Psychotherapy would be discussing the underlying issue of why the group members are on a RX (ie PTSD, depression)

    CPT 90862 is an individual service (RX mgmt with minimal therapy) and can't be coded for group services.

    90862 is not simply "renew my perscription". Here is a paste of expected documentation for 90862. It would seem to be such a violatiion of confidentiality if each patient had to answer all this or be assessed by the provider in a group setting

    Documentation of medical necessity for pharmacological management (procedure code 90862) must address all of the following information in the patient's medical record in legible format:
    • Date and time
    • Diagnosis โ€“ update at least annually
    • Interim Medication history
    • Current symptoms and problems that include any physical symptoms
    • Problems, reactions, and side effects, if any, to medications and/or ECT
    • Current Mental Status Exam
    • Any medication modifications
    • The reasons for medication adjustments/changes or continuation
    • Desired therapeutic drug levels, if applicable
    • Current laboratory values, if applicable
    • Anticipated physical and behavioral outcome(s)
    Not to argue with your advice, but where does it state that 90862 in an individual and cant be in a group?
    Is it a violation of anything if the patient agrees to do this and wants to do this?? Obviously they wouldn't be forced to do this in a group if they would prefer alone...

  4. Default
    I'm not familiar with 90862 being done in a group setting. Can you give a scenario on how this service would be provided.

    To keep it simple, let's assume there is a group of 10 and they have all given consent to waive their right to confidentialty during this group.

  5. #5
    Default
    Well, I do know it would be smaller groups. I am not entirely sure at this point how dr is intending to run these sessions, if we can do it. From what little I got, he wants basically to go through each patients meds and others can listen to issues they may be having with meds as they can relate to it and ask questions. I will see if I can get a more detailed plan of what he has in mind for this.

  6. Default
    If he is going to sit in front of the group with 10 charts in his lap and go thru each one and discuss the RX, discuss how the patient is responding on the RX, any issues or concerns and answer questions from the group, I would be inclined to code 90853 for each participant

    It appears he is trying to provide an individual service in a group setting. You might provide him some guidelines on what is involved in providing and documenting 90862

    Also if the group members are going to discuss personal information in the group, you need to make sure you get an informed consent signed from each and keep it on file

    You know what he wants to do but I just don't have a good feeling on this. The RVU for 90862 is about 1.60 while for 90853 it is about .88. Is he doing this to pump up his reimbursement? Strong documentation will be required should he be audited for coding 90862 in a group

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