90792 vs 99204/5

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nexus73

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Hi, thanks in advance for any advice. I'm just starting an outpatient clinic in an employed position with pay based on RVUs (there is a salary guarantee which I get paid if RVUs don't exceed it).

The basic issue is this: a 90792 is worth 3.25 RVUs, whereas a 99204 is 2.43 and 99205 is 3.17. What the insurance companies actually pay the clinic does not affect my income, only the RVU values matter. So for initial evaluations it looks like I'm better off billing 90792 for the higher value. If I use the e/m codes (99204/5), it will probably be a mix of the two with an average in the 2.7 RVU range overall.

Can anyone tell me the basic requirements for a 90792, and any restrictions or pitfalls to look out for when using this in the outpatient setting? Are there specific requirements for content of certain sections of the note...e.g. does the mental status examination need to have certain components to qualify (like a 99205 requires a "comprehensive" MSE). I'm used to billing inpatient e/m codes (99221-223) based on either complexity or time, so I think I've got the basics of 99204/5 down because they have similar rules.

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There are no specific requirements for a 90792. Just make sure you’re documenting what you would typically document and you should be fine.
 
Hi, thanks in advance for any advice. I'm just starting an outpatient clinic in an employed position with pay based on RVUs (there is a salary guarantee which I get paid if RVUs don't exceed it).

The basic issue is this: a 90792 is worth 3.25 RVUs, whereas a 99204 is 2.43 and 99205 is 3.17. What the insurance companies actually pay the clinic does not affect my income, only the RVU values matter. So for initial evaluations it looks like I'm better off billing 90792 for the higher value. If I use the e/m codes (99204/5), it will probably be a mix of the two with an average in the 2.7 RVU range overall.

Can anyone tell me the basic requirements for a 90792, and any restrictions or pitfalls to look out for when using this in the outpatient setting? Are there specific requirements for content of certain sections of the note...e.g. does the mental status examination need to have certain components to qualify (like a 99205 requires a "comprehensive" MSE). I'm used to billing inpatient e/m codes (99221-223) based on either complexity or time, so I think I've got the basics of 99204/5 down because they have similar rules.
Hi, thanks in advance for any advice. I'm just starting an outpatient clinic in an employed position with pay based on RVUs (there is a salary guarantee which I get paid if RVUs don't exceed it).

The basic issue is this: a 90792 is worth 3.25 RVUs, whereas a 99204 is 2.43 and 99205 is 3.17. What the insurance companies actually pay the clinic does not affect my income, only the RVU values matter. So for initial evaluations it looks like I'm better off billing 90792 for the higher value. If I use the e/m codes (99204/5), it will probably be a mix of the two with an average in the 2.7 RVU range overall.

Can anyone tell me the basic requirements for a 90792, and any restrictions or pitfalls to look out for when using this in the outpatient setting? Are there specific requirements for content of certain sections of the note...e.g. does the mental status examination need to have certain components to qualify (like a 99205 requires a "comprehensive" MSE). I'm used to billing inpatient e/m codes (99221-223) based on either complexity or time, so I think I've got the basics of 99204/5 down because they have similar rules.

Since it’s a ‘psych eval’, it should probably have the components of a psych eval. The HPI can be briefer than a 99205 but I would typically make sure there is a social, family, medical history and review of systems as well. The other thing about it is that there are limitations on how often a provider or practice can use this code for a specific patient.
 
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Follow up question: I saw a patient in our hospital system 2 and 1/2 years ago during an inpatient admission. I'm now working outpatient in the same system. He's been out of the area all this time and is now referred to my clinic. Can I bill a 90792 when I see him for his outpatient visit?
 
Follow up question: I saw a patient in our hospital system 2 and 1/2 years ago during an inpatient admission. I'm now working outpatient in the same system. He's been out of the area all this time and is now referred to my clinic. Can I bill a 90792 when I see him for his outpatient visit?
There's no time needed between billing 90792. I've done it for the same patient more than once per year when they've went away to inpatient and then PHP for several months before returning to me in outpatient.
 
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