Psychiatry Coding & Reimbursement Alert

Question: I understand that we now have to use an E/M code to report medication management when it is done by a psychiatrist and use +90863 when the pharmacological management is performed by a psychologist who has prescribing privileges but cannot use an E/M code to report his services. My question is should we use any one particular CPT^® code to report pharma management performed by our psychiatrist or will it differ from patient to patient?

Louisiana Subscriber

Answer: You’re correct that you now need to use an evaluation and management (E/M) code to report medication management when it is performed by your psychiatrist and use +90863 (Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services [List separately in addition to the code for primary procedure]) as an add-on code to psychotherapy service when the pharmacological management is performed by a professional who has prescribing privileges but cannot report an E/M service.

However, there is no one particular E/M code that is specific to medication management services performed by your psychiatrist. You will have to determine the appropriate E/M depending on the history, exam, and medical decision making that was involved, just as you do when choosing the level of E/M service in most other situations.

If your psychiatrist is reviewing the records, checking for adverse effects, making adjustments to the dose and such you can probably claim for this service using 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components…).

If the medication management only involved providing a fresh refill of the earlier prescription, a base level E/M service, such as 99212, is probably more appropriate, since the medical decision making in that situation will likely be straightforward and any history or exam will likely be problem-focused. If there was any other complicating factors that increased the complexity of the service provided, you may be able to claim a higher level of E/M, but documentation as to why such a level of E/M code was claimed should support the claim forms that you are submitting.