DRG Coding Advisor: National emergency leads to more depression coding

Start with patient’s medical record

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.