Correct Coding For ADD Follow-up Visits

Correct Coding For ADD Follow-up Visits

Since attention deficit disorder is so prevalent, medical billing knowledge must also be. ADD walks a thin line between mental health coverage and medical coverage to many payers. To get reimbursed correctly for ADD follow-up visits, correct medical billing is necessary.

There are two types of medical billing codes to use for ADD follow-up visits: mental health codes, and evaluation/management codes. 90862 (Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy) is the mental health code. Many insurance companies will deny this medical billing if your physician is not a mental health provider.

The evaluation and management codes are 99212-99215. Not only will this code cover your expenses for the medication management, but it also reimburses you for the evaluation portion of a visit. The medical billing code 90862 merely reimburses for the medication portion of the exam.

The current procedural terminology definition of 90862 allows providers who are not mental health providers to receive reimbursement. However, insurance companies end up denying these claims because many times there is a mental health carve out plan. This means that mental health is not covered under the medical plan at all.

Sometimes there is no way in medical billing to get away from a denial. The evaluation and management CPT codes help, but some insurance companies won’t pay for this if the diagnosis is mental health related. Most of the time, the medical billing ADD code is 314.XX. This signifies mental health for many payers and they will deny your claim. This is when you can charge the patient directly for your services.

Mental health many not be something your medical billing staff are accustomed to handling. Be sure they are fully aware of all the policies associated with mental health medical billing.

View all Articles by: Melissa Clark, CCS-P