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.
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.