EM Coding Alert

Question: Can you bill separately for these three services if the physician performs them?: 99212, +90833, and +90863. Is the medication management bundled in the E/M code?

New York Subscriber

Answer: Coding for these services might depend on the payer’s policy. If the Correct Coding Initiative (CCI) edit holds priority over the CPT^® parenthetical, then the answer is no.

Per the April 1, 2017 CCI edits, +90863 (Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services [List separately in addition to the code for primary procedure]) is a Column 2 code for 99212 (Office or other outpatient visitfor the evaluation and management of an established patient, which requires at least 2 of these 3 key components …). This means you cannot bill the codes together under any circumstances.

According to a parenthetical note in the 2017 CPT^® manual for +90863, “For pharmacologic management with psychotherapy services performed by a physician or other qualified healthcare professional who may report evaluation and management codes, use the appropriate evaluation and management codes 99201-99255, 99281-99285, 99304-99337, 99341-99350 and the appropriate psychotherapy with evaluation and management service 90833, 90836, 90838.”

According to the 2017 CPT^® manual, if a patient receives an E/M service on the same day as a psychotherapy service by the same physician or qualified healthcare professional, to separately report the E/M service and psychotherapy, the medical documentation must show that the two services are significant and separately identifiable.

You would report the psychotherapy service with +90833 (Psychotherapy, 30 minutes with patient when performed with an evaluation and management service [List separately in addition to the code for primary procedure]); +90836 (Psychotherapy, 45 minutes with patient when performed with an evaluation and management service …); or +90838 (Psychotherapy, 60 minutes with patient when performed with an evaluation and management service …) as add-on codes to the E/M service.

You can report +90833 in conjunction with:

• Office or other outpatient services, 99201-99215
• Hospital observation services, 99217-99226
• Subsequent hospital care services, 99231-99239
• Consultation Services, 99241-99255
• Nursing facility services, 99304-99318
• Domiciliary, rest home [eg. boarding home] or custodial care services, 99324-99337
• Home services, 99341-99350

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]) is an add-on code, so you must report it with an appropriate primary code like 90832 (Psychotherapy, 30 minutes with patient), 90834 (… 45 minutes with patient), or 90837 (… 60 minutes with patient), according to CPT^®. In other words, the 90863 must be reported with its parent service. With this code, the parent service would be an E/M service or another psychotherapy service (examples 99201-99255 or a 90833).