Psychiatry Coding & Reimbursement Alert

Published on Mon Sep 14, 2015 PDF

Question: I am new to psychiatry coding. I recently reported 90792 for an initial evaluation performed by our clinician. I reported 4 units of the code for four hours that my clinician spent on review of records, interview of the patient, and preparation of the report. All this was performed on the same calendar date of service. But, my claim was denied. What did I do wrong?

Missouri Subscriber

Answer: When your psychiatrist performs an initial psychodiagnostic evaluation with medical services, you report 90792 (Psychiatric diagnostic evaluation with medical services) for the service provided. As you see from the descriptor to 90792, there is no time component involved in reporting the service. So, you will only report one unit of the code on one calendar date of service, irrespective of the number of hours your clinician spent in performing review of records, interview of the patient, and preparation of the report. As the CPT^® guidelines state, “Codes 90791, 90792 may be reported once per day . . . .”

Although some payers may limit the number or frequency of 90792 that they will pay (e.g., one unit per episode of illness for a patient), CPT^® states that you may report the code more than once for the patient when separate diagnostic evaluations are conducted with the patient and other informants on different calendar dates of service. CPT^® advises you to report services as being provided to the patient and not the informant or other party in such circumstances.

According to the American Psychiatric Association (APA), Medicare will only pay for one unit of 90792 in a year for institutionalized patients unless you can establish medical necessity for more than one unit of 90792. APA says that you can also report 90792 when your psychiatrist is seeing the patient after a span of three years.

So, don’t make a claim based on the number of hours your clinician spent on one calendar date of service or the number of encounters he undertook on one calendar date of service. Also, don’t consider preparation of reports on another calendar date of service as an extended evaluation and report additional units of 90792.