when do you use 90792 code?

[Ahamis]

I wonder in what situations psychiatrists use 90792 code.

If you are doing an initial evaluation in two separate visits, would be ok to bill 99204/99205 for the first visit and 90792 for the second visit?
what is your approach for intakes that takes more time than you expected?

Thank you.

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[splik]

If you work in an RVU based practice, then using 90792 for initial evals makes sense. Otherwise, it doesn't make sense unless you have peculiar insurance contracts that reimburse more for it than the E&M codes.

Depending on the insurance you may be able to do Initial E&M for visit one and 90792 for visit 2. 90792 is a psych diagnostic eval code. It is not limited to use for initial sessions and can be used more than once (up to 3 times often depending on the insurance). However it would be unusual to do this. More common would be 90792 x2 OR 99205 and 99214+9083x for visit 2.

 

[calvinhobbes]

Initial visit eval for outpatient

 

[J ROD]

I was always taught that if they have been seen by your practice within the last 3 years outpatient you could not do an initial evaluation. However, I have heard others use the 90792 when seeing a new to them patient from a another provider in the practice. I did not do it as I was unaware when I took over couple hundred patients from NP that left the practice.

 

[psych_0]

On the inpatient unit 90792 is truly the burnout reducer for me. When I see the same malingerer I have discharged 4x in the last month, I used to feel an internal sense of annoyance and frustration. Now I celebrate these admissions because I know they will not take me long (90+% of the time) but still get me 4.16 wRVU.

 

[Stagg737]

Depending on the insurance you may be able to do Initial E&M for visit one and 90792 for visit 2. 90792 is a psych diagnostic eval code. It is not limited to use for initial sessions and can be used more than once (up to 3 times often depending on the insurance). However it would be unusual to do this. More common would be 90792 x2 OR 99205 and 99214+9083x for visit 2.

Is the bolded for the outpatient setting? How does that work? I thought each 90792 required "a full psychiatric evaluation with medical assessment" to use it, how do you justify doing that on back to back outpatient appointments when you're not completing a full eval during either one? Or am I misunderstanding?

To OP, we use this for ER evaluations and initial psych evals on the medical floors for consults. I can see a patient multiple times in a week or back to back days for separate ER visits. I also use this for initial evals outpatient unless I need to use time-based codes. I probably use it for 98%+ of new patient encounters. If intakes take too long then I just use 99205 + 99417x however many extra 15 minutes (need at least 2 to hit the same wRVUs as 90792, so at least 94 minutes). I'm paid based on RVU production.

 

[splik]

Is the bolded for the outpatient setting? How does that work? I thought each 90792 required "a full psychiatric evaluation with medical assessment" to use it, how do you justify doing that on back to back outpatient appointments when you're not completing a full eval during either one? Or am I misunderstanding?

Some people complete the diagnostic assessment over 2-3 visits. This is common in CAP and more complex cases.

 

[TexasPhysician]

Academic buddy gets bonuses based on RVU’s and 90792 has higher RVU’s.

I earn more with 99204 + 90833, so I use that.

 

[Stagg737]

Some people complete the diagnostic assessment over 2-3 visits. This is common in CAP and more complex cases.

So what are the restrictions here? What stops someone from just doing 3 30 minute "eval" appointments and billing a 90792 for each one since there's no time basis for 90792? Per CMS (their website) the requirements are:

- Elicitation of medical and psych hx (including past, family, and social)
- MSE
- Establishment of an initial diagnosis
- Eval of the patient's ability and capacity to respond to treatment
- Initial plan of treatment
- Reported once per day and NOT on the same day as an E/M service performed by the same individual for the same patient
- Covered once at the outset of an illness or suspected illness

That last line seems pretty clear that you can only bill this once for an eval, so how are people billing this twice? Or are they doing a full eval for different conditions/problems on each eval? I still don't understand how CMS wouldn't be coming after people for doing this...

 

[calvnandhobbs68]

So what are the restrictions here? What stops someone from just doing 3 30 minute "eval" appointments and billing a 90792 for each one since there's no time basis for 90792? Per CMS (their website) the requirements are:

- Elicitation of medical and psych hx (including past, family, and social)
- MSE
- Establishment of an initial diagnosis
- Eval of the patient's ability and capacity to respond to treatment
- Initial plan of treatment
- Reported once per day and NOT on the same day as an E/M service performed by the same individual for the same patient
- Covered once at the outset of an illness or suspected illness

That last line seems pretty clear that you can only bill this once for an eval, so how are people billing this twice? Or are they doing a full eval for different conditions/problems on each eval? I still don't understand how CMS wouldn't be coming after people for doing this...

Codes 90791, 90792 may be reported more than once for the patient when separate diagnostic evaluations are conducted with the patient and other informants

https://zerosuicide.edc.org/sites/default/files/Safer%20Suicide%20Care%20Billing%20Tip%20Sheet.pdf

Not with CMS though, CMS only lets you do this once as you pointed out but a lot of private insurances will let you do it more than once.

This is pretty common in CAP I’ve known a couple people who would do 2x 90792s for intakes, once primarily with parents and one primarily with the patient.

 

[Stagg737]

Codes 90791, 90792 may be reported more than once for the patient when separate diagnostic evaluations are conducted with the patient and other informants

https://zerosuicide.edc.org/sites/default/files/Safer%20Suicide%20Care%20Billing%20Tip%20Sheet.pdf

Not with CMS though, CMS only lets you do this once as you pointed out but a lot of private insurances will let you do it more than once.

This is pretty common in CAP I’ve known a couple people who would do 2x 90792s for intakes, once primarily with parents and one primarily with the patient.

Makes sense. I was always taught to just use it for the initial eval, but billing education in residency was grossly oversimplified and overly conservative in some aspects.

 

[Sushirolls]

I use 90792 in my private practice when I have the rare very fast consult that doesn't hit an hour. Or for some reason the note itself is very anemic. Typically I do 90 minutes 99205 with two 99417 add ons.

 

[lol.psych]

I use 90792 in my private practice when I have the rare very fast consult that doesn't hit an hour. Or for some reason the note itself is very anemic. Typically I do 90 minutes 99205 with two 99417 add ons.

Seconded.
(Though I haven’t had a consult take less than an hour, esp since the codes include stuff outside the appointment — reading the extensive intake questionnaire, reviewing labs if they have them, documentation, reaching out to their therapist/sending ROIs to establish contact…)
My typical intake is 99205+99417+99417.

 

[Merovinge]

Seconded.
(Though I haven’t had a consult take less than an hour, esp since the codes include stuff outside the appointment — reading the extensive intake questionnaire, reviewing labs if they have them, documentation, reaching out to their therapist/sending ROIs to establish contact…)
My typical intake is 99205+99417+99417.

I use 90792 in my private practice when I have the rare very fast consult that doesn't hit an hour. Or for some reason the note itself is very anemic. Typically I do 90 minutes 99205 with two 99417 add ons.

It's wild how good psychiatric care makes me excited, I get a little beaten down by reading awful records from other places/doctors. Awesome you both do evals like that for your patients.