Psychiatry Coding & Reimbursement Alert

You Be the Coder:

E/M Codes For Psychologist's Med Management? Think Again

Published on Wed Dec 10, 2014

Question: One of our psychologists in our practice is insisting on using E/M codes and add-on psychotherapy codes when he performs pharmacological management and psychotherapy sessions. He says that since E/M codes include the term “qualified healthcare professionals” in its descriptor, it is all right to use E/M codes for med management performed by psychologists. Is this correct?

Illinois Subscriber

Answer: Even though the descriptors to E/M codes carry the verbiage “qualified healthcare professionals,” psychologists are not allowed to use E/M codes for any medication management or any other evaluation of the patient.

Instead of using E/M codes for pharmacological management, your psychologist has to use the add-on +90863 (Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services [List separately in addition to the code for primary procedure]). Since this is an add-on code, you will have to report the psychotherapy code from the CPT® codes 90832 (Psychotherapy, 30 minutes with patient and/or family member), 90834 (…45 minutes…) or 90837 (…60 minutes…) depending on the time spent for the psychotherapy session.

You should note that you can use +90863 for med management services only if your psychologist has prescribing privileges and fulfills all other guidelines laid down by your state. So, check your state rules for the guidelines to see if your psychologist is allowed to prescribe medications to his patients and whether or not you can report the add-on code for pharmacological management.

Reminder: You should not count the time spent on pharmacological management into the time spent for the psychotherapy session. So, when your psychologist performs medication management, you should separately count this time and only use the time spent on the psychotherapy aspect to calculate the appropriate psychotherapy code.

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