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Optometry Coding & Billing Alert

You Be the Expert:
Don't Look to 90863 for Med Management

Question: Which code(s) should we report to describe our services providing medication management? We tried using +90863 but it was denied.

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Answer: If you perform medication management, you should use the appropriate E/M code, which you can either report based on the elements of history, exam, and medical decision-making or based on time, when appropriate.

Typically, you won’t collect for +90863 (Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services [List separately in addition to the code for primary procedure]) when you perform medication management in your optometry practice. This code is mainly geared toward mental health professionals who are licensed by their state but cannot report E/M codes.

Remember that neither the E/M codes nor the medication management code will be applicable if the patient simply presents to your office to pick up a prescription for a medication refill from the receptionist. In these cases, you should not bill any code at all.