CPT Q&A

Q:I am called in to nursing homes to treat patients with Alzheimer's and other dementias who are suffering from depression or anxiety disorders. I meet with the patients to evaluate them and then determine what medication will best treat their symptoms. Should I be using a consultation code (99251-99255) or an initial diagnostic interview code (90801)?

A: You can use either a consultation code (most likely a 99254 or 99255) or the initial diagnostic interview code. For follow-up visits, you can use the medication management code (90862) or one of the subsequent hospital care codes (99231-99233). No matter which code you use, you must be sure that the service you provide has been ordered by an attending physician and that this is noted in the patient's chart.

Another very important issue for payment in these cases is the diagnosis code. Even though you are prescribing the medication for a secondary symptom, you want to be sure to use the dementia code for the patient's primary diagnosis so that you will be properly reimbursed at Medicare's 80 percent rate. Treatment for Alzheimer's and related disorders is not subject to the outpatient mental health services limitation and is reimbursed at 80 percent rather than 50 percent. ▪