When would it be appropriate for a psychiatrist to bill 90791 instead of 90792?

Discussion in 'Psychiatry' started by SpongeBob DoctorPants, Jan 11, 2019.

  1. SpongeBob DoctorPants

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    I conducted a new patient evaluation for a young child with anxiety. I recommended therapy as the initial approach and said that if things do not improve with therapy alone we may consider medication. I didn't get into specifics about medication (such as SSRIs, side effects, etc.) and the parent didn't really want to pursue medications at this time anyway, so we left it at that. Would this brief discussion of medication be considered medical services as required for 90792, or would this be an evaluation without medical services?
     
  2. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    Did you conduct anything in the realm of a physical exam and discuss medication options?
     
  3. OP
    OP
    SpongeBob DoctorPants

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    Vital signs were performed, but other than that, just the standard mental status exam and a brief comment about maybe using medications later, though I did not discuss specific medication options.
     
  4. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    My gut tells me that you are probably fine with 90792 as prescribing new meds or changing meds are not required for billing. As long as you document the vital signs and the brief discussion on medication management, should be ok. Do you have the option to flag the note for coder review in your system if unsure?
     
  5. TexasPhysician

    Moderator Physician Verified Expert 10+ Year Member

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    You would bill 90792. Part of our evals are some sort of physical exam and at least mentally considering/assessing for need of medication. Discussing or prescribing meds is not a requirement for 90792 to my knowledge.
     
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  6. Crayola227

    Crayola227 The Oncoming Storm
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    I was taught for billing that observing the patient under general, neuro, and psych (basically what you can see, gait, symmetrical facial movements with no droop, grooming, body habitus, psychomotor, etc) all counts for physical exam even if you don't lay hands on the patient to assess and are merely using your observation. That an aside from if you're assessing enough points under each systems for the sort of note you're billing, but the point is that a "physical exam" doesn't have to include touching the patient, nor does that make it only a psychiatric exam.
     
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  7. nexus73

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    I I can’t think of any reason a psychiatrist wouldn’t bill 90792 as long as you’re actually covering everything in your eval including a review of systems.
     
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  8. splik

    splik Professional Cat at Large
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    The APA says psychiatrists should never use 90791, it's meant for psychologists and other non-physicians. Since we are physicians, by definition we are providing medical services. you dont even have to prescribe meds or order labs but consider. a review of systems in not required. the requirements are quite loose. Per CMS all that is required is:

    Elicitation of a complete medical and psychiatric history (including past, family, social)
    Mental status examination
    Establishment of an initial diagnosis
    Evaluation of the patient’s ability and capacity to respond to treatment
    Initial plan of treatment
     
  9. nexus73

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    Thanks for this post. Do you know if these terms (ability vs capacity) are meaningfully different?
     

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