Physician's Coding Strategy: National emergency leads to more depression coding
The combination of the holiday season and emotional reactions to the events on and after Sept. 11 mean practices are seeing a major jump in the number of patients with some form of depression.
When treating such patients, your code selection starts with the patient’s medical record. For ICD-9-CM subcategories 296.0-296.6, make sure to use the correct fifth-digit subclassification code to identify the extent of the patient’s condition. These are:
- 0 — unspecified;
- 1 — mild;
- 2 — moderate;
- 3 — severe, without mention of psychotic behavior;
- 4 — severe, specified as with psychotic behavior;
- 5 — in partial or unspecified remission;
- in full remission.
Reactive depression is the result of such stressful events as the death of a loved one, the loss of a job, or the end of a relationship. The patient experiences mild to moderate depression, but is able to continue his or her life, usually within a few months.
If the medical record says the patient’s condition is "situational" or "adjustment reaction with depressed features, in a patient with no previous existing mental disorders," it is usually coded 309.0 (brief depressive reaction) or 309.1 (prolonged depressive reaction). Caution: Codes from the 309 category should not be assigned with any other code in the "Mental Disorders" chapter of the ICD-9-CM code book.
Use CPT code 90862 (pharmacological management) if:
- the physician is managing medication for a patient receiving psychotherapy from a limited-licensed colleague;
- the patient’s condition is being effectively treated by medications only;
- the physician is managing medications for a patient with an organic disorder such as senile dementia;
- the patient is receiving no other services during the encounter;
- an evaluation and management psychotherapy service is provided during the same encounter.
Remember that only the appropriate evaluation and management or psychotherapy code should be assigned.
If a Medicare patient receives an uncomplicated drug monitoring, such as an adjustment in the dosage, assign HCPCS Level II code M0064. For comprehensive drug management services, assign CPT code 90862.
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