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Coding refills for ADHD medications

Nikhil Answered Mon 24th of January, 2011 22:13:48 PM

There was some discussion in the Pediatric conference about the use of 90862 for refills for ADHD medications. Could you please clarify that code for me?

SuperCoder Answered Mon 24th of January, 2011 22:20:19 PM

From CPT Assistant, Summer 1992 page 9:
90862Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
This code is reported when the physician manages medication for the patient who is in psychotherapy with a non-physician colleague, when a patient's condition is being effectively treated by psychotropic drugs alone or when a physician is primarily managing a patient who has an organic type disorder (e.g., senile dementia of the Alzheimer's type) with the use of medication. (i.e., The physician is evaluating how the medication is affecting the patient, determining the proper dosage level and prescribing medication for the patient for the period of time before the patient is next seen.)
Generally, this patient is not receiving other services from the physician at that encounter. If an evaluation and management service were provided at that encounter, the pharmacologic management would be included in the E/M service; in this case the level of service code reported by the physician should include the pharmacologic management as well as the other evaluation and management services provided at that encounter. The psychotherapy provided in conjunction with the reporting of 90862 is very minimal and is basically supportive.

From Pediatric Coding Alert:
Capture Monthly Refills With 2 Options
Option 1: If the patient comes into the office for an ADD/ADHD medication refill, report a nurse visit incident-to the on-duty physician (99211, Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician - typically, 5 minutes are spent performing or supervising these services).
During monthly visits for medication renewal, the nurse takes “an interval history with questions about the patient’s sleeping and eating habits and any school or behavior issues,” Tuck says. This medically necessary service must be carefully documented.
Option 2: You may consider using 90862 (Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy), which is a well-paid code for medication management. Because 90862 is in CPT’s psychiatry section, insurers may have mental-health carve outs that restrict coverage of such codes to mental-health providers.
Couple 90862 or 99211 with V58.69 (Long-term [current] use of other medications). The V code describes an encounter for medical management, which is why the patient requires these services.

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