Psychiatry Coding & Reimbursement Alert

Question: I was earlier using 90862 for pharmacological management when our psychiatrist performed review of medications and adjustments to the dose of the medication. I see that the code 90862 has now been eliminated and a new code 90863 has taken its place. Should I now use 90863 instead of 90862?

Minnesota Subscriber

Answer: 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.

Since you are billing the services for a psychiatrist, you will have to report the appropriate E/M code for the session along with an add-on code for the psychotherapy performed and not use the new code +90863 with the appropriate psychotherapy code.

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.