Primary Care Coding Alert

Question: Our family physician recently saw a 12-year-old established patient with attention deficit disorder for medication monitoring (this child is on Ritalin). Notes indicate that the physician performed history, exam and medical decision-making -- and he also provided the patient with some psychotherapy. Should I report 90862, an evaluation and management code, or both?

Connecticut Subscriber

Answer: Even though 90862 (Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy) may seem appropriate for this encounter, you-re better off coding for an E/M service instead.

There are two reasons that an E/M is the better option:

• Code 90862 is a psychiatric services code. Family medicine coders could encounter troubles with their insurer when reporting 90862, because many payers do not consider FPs as mental-health providers.
• The FP provided psychotherapy and E/M service. Code 90862 is for encounters in which the physician performs only a medication check. In your scenario, the FP checked the patient's meds, then performed psychotherapy and all the components of an E/M.

The summer 1992 CPT Assistant advises that if an E/M service is provided at a medication check, the pharmacologic management would be included in the E/M service. In this case, the level of E/M service code the physician reported should include the pharmacologic management as well as the other E/M services provided at that encounter.

Best bet: Choose the appropriate E/M based on the level of service. For example, if notes indicate a level-four E/M, you should:

• report 99214 (Office or other outpatient visit for the E/M of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity) for the E/M.
• link 314.00 (Attention deficit disorder; without mention of hyperactivity) to 99214 to represent the patient's ADD.