Coding Cues: Medication management

March 21, 2008

Patients with multiple health problems and multiple meds often ask-in many cases, repeatedly-why they take so many pills or why they need a particular drug. A time-consuming review of the function of each medication generally follows, along with a discussion of the benefit to the patient, indications and contraindications, and possible alternatives. Since this typically occurs after I've completed a physical exam, can I use code 90862 "Pharmacologic Management" in addition to the level of service for these patients?

Patients with multiple health problems and multiple meds often ask-in many cases, repeatedly-why they take so many pills or why they need a particular drug. A time-consuming review of the function of each medication generally follows, along with a discussion of the benefit to the patient, indications and contraindications, and possible alternatives. Since this typically occurs after I've completed a physical exam, can I use code 90862 "Pharmacologic Management" in addition to the level of service for these patients?

The 90862 code would not be appropriate under the circumstances you describe. That's because the full description of this code is "Pharmacologic management, including prescription, use and review of medication with no more than minimal medical psychotherapy." You may, however, bill the visit based upon time if more than 50 percent of the visit was devoted to counseling and coordination of care. Be sure to document the total length of the visit and what percentage was spent in counseling, as well as the topics discussed.