Coding Consult

Answers to your questions about . . .

Billing for psychiatric codes

Q: Can I use 90862 for follow-up visits of patients on antidepressant medication? Because it's a psychiatric code, I'm afraid of denials.

A: Yes, primary care doctors can use 90862 (pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy). CPT indicates that a physician does not have to be a psychiatrist to use psychiatric codes. Use this code if the following applies:

• You manage medication for the patient who is in psychotherapy with a nonprescribing colleague.
• The patient's condition is being effectively treated by psychotropic drugs alone.
• You are primarily managing a patient who has an organic-type disorder (e.g., Alzheimer's disease) with the use of medication.

Usually, you don't provide other services at follow-up visits for patients who started on antidepressants. However, if you see the patient for another complaint—say, a sore throat—you can code only for the E&M service because it includes the pharmacologic management as one of the medical decision-making components.

When a patient wants only a referral

Q: A woman saw an ob/gyn for pregnancy-related care and needed to visit a specialist for a test. Her health plan requires a referral from a primary care physician, so the woman, who had never been seen in our office, came to me. I didn't do any exam because the ob/gyn had already done it.

How should I code this visit? ICD-9-CM code V68.81 seems to apply. If I use this code, can I use 99212 for the CPT code? I thought I had to use well-visit codes with V codes.

A: V68.81 (encounters for administrative purposes; referral of patient without examination or treatment) is an appropriate ICD-9-CM code for the scenario you describe. Select your CPT code based on the key components: history, exam and medical decision-making.

It appears you provided only two of the key elements of an E&M visit—history and medical decision-making. Because no treatment was rendered, the medical decision-making appears to be straightforward.

Assuming you obtained at least a focused history, 99212 would be appropriate. Because you didn't perform even a minimal exam, you can't code a new patient visit. All three of the key components must be documented in order to use the E&M codes for new patients (99201-99205). A preventive care code also would not be appropriate because you didn't do a comprehensive exam.

Bundling Xylocaine injections with excision codes

Q: I removed six papillomas from a patient and administered three Xylocaine injections to numb the various areas. Can I bill for these injections in addition to the papilloma removals, or are they bundled?

A: The Xylocaine injection is considered local anesthesia and is therefore bundled with the excision code. Surgical procedures include local infiltration, metacarpal/metatarsal/digital block and topical anesthesia. You should report only the code for the papilloma removal.

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Coding Consult: Answers to your questions about. . ..

Medical Economics

2002;20:17.