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psychiatric follow-up evaluation and pharm management california

Thomas Posted Tue 09th of April, 2013 14:36:33 PM

What do I bill for a Psychiatric Follow-up Evaluation with Pharmacological Management? I've thought about 90792 with a report code of 99080. I was billing 90862 in 2012 but I've been told that those codes no longer exist. 90863 only works in two states and I'm in california. what CPT should I be billing if it's a follow-up evaluation WITH pharmacological management?

SuperCoder Answered Tue 09th of April, 2013 15:18:56 PM

You’re right that the CPT® code 90862 has been eliminated in the changes that came into effect on Jan.1, 2013. Even though the alternative to 90862 was created in the form of the CPT® code, +90863 (Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services [List separately in addition to the code for primary procedure]), you will have to apply restraint in the use of this code. You will have to use +90863 as an add-on code when medication management is performed in addition to psychotherapy services.

Since psychiatrists may report evaluation and management services (E/M), they are not supposed to claim medication management with +90863 when they perform these services and provide psychotherapy. Instead, they will have to use the appropriate E/M codes to denote the medication management services that they performed and report the psychotherapy services as an add-on code (e.g. with +90833, +90836, or +90838).

You will therefore use +90863 when medication management is provided by prescribing psychologists or other non-medical practitioners who are licensed by their state to prescribe but are not qualified to bill evaluation and management services. In such situations, code +90863 would be reported in addition to one of the following psychotherapy codes: 90832, 90834, or 90837.

Reminder: When providing these services to a Medicare patient, you can continue to use the HCPCS code M0064 (Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders) as you were previously doing.

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