Know Your Codes: 90791
90791: Psychiatric Diagnostic Evaluation without Medical Services
The evaluation may include communicating with family or other sources, as well as reviewing and ordering non-medical diagnostic studies. Psychiatric Diagnostic Evaluation with medical services (90792) as above (90791), the evaluation may include communicating with family or other sources, as well as reviewing and ordering diagnostic studies. It must include medical services. “Medical services” refers to “medical thinking” as well as medical activities (e.g., physical examination, prescription of medication, and review and ordering of medical diagnostic tests). Medical thinking must be documented (eg, consideration of a differential diagnosis, medication change, change in dose of medication, drug-drug interactions).
The 90791 code is used for psychiatric diagnostic evaluations without medical services. It was created in 2013, along with 90792, to replace the former psychiatric diagnostic evaluation codes 90801 and 90802.
According to the CPT manual, 90791 is an “integrated biopsychosocial assessment, including history, mental status, and recommendations.” The manual goes on to say that the evaluation may include “communication with family or other sources and review and ordering of diagnostic studies.”
In general, the code can be used by psychiatrists, clinical psychologists, licensed professional counselors, licensed clinical social workers, and licensed marriage and family therapists. However, when billing to Medicare and Medicaid, certain states may not allow reimbursement for non-psychiatrists, so be sure to check your state’s laws first.
Comparing 90791 and 90792
There’s one major difference between 90791 and 90792: the use of medical services.
- Whereas both codes are used for psychiatric diagnostic evaluations, 90791 can’t include medical services and 90792 can. Medical services may consist of any medical activity, such as writing prescriptions, performing physical exams, and modifying psychiatric treatment.
- You can bill 90791 and 90792 in conjunction with the interactive complexity code (90785), but can’t bill both codes on the same day as psychotherapy or E/M (evaluation and management) service performed by the same individual for the same patient.
Billing 90791 with 90792
You can bill 90791 and 90792 on the same day if:
- The 90791 assessment is completed by a clinician (like a social worker) and a 90792 assessment is completed by a psychiatrist
- It aligns with the payer policy
- If you bill both codes on the same day, though, it’s possible the payer will question why two clinicians did an initial evaluation and may not be willing to reimburse for both codes.
For both 90791 and 90792
- In certain circumstances, one or more other informants (family members, guardians, or significant others) may be seen in lieu of the patient.
- Both codes may be reported more than once for the patient when separate diagnostic evaluations are conducted with the patient and other informants on different days.
- Use the same codes, for later reassessment, as indicated.
- Do not report on the same day as psychotherapy or an E/M service.
- If present, the interactive complexity component of the diagnostic evaluation is captured by reporting the interactive complexity add-on code 90785 in conjunction with 90791 or 90792.
To possibly get around this, you could have the clinician bill for 90791 and the psychiatrist bill using the E/M consult codes (99241-99245). You could also have the psychiatrist use the initial hospital care E/M codes (99221-99225), which would cover both the consult and initial psychiatric evaluation, but that requires the patient being admitted to the inpatient psychiatric service.
For accurate Mental/Behavioral Health medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we will discuss the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate Mental/Behavioral Health medical billing and coding. To know more about our services call us at 302-231-1286 or write to us at info@e2eMedicalBilling.com