Psychiatry Coding & Reimbursement Alert
Don't Downcode to Receive Higher Reimbursement for Psychodiagnostic Evaluation
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Question: I was going through the RVUs allocated to the newly introduced codes in psychiatry. When I was checking this, I was surprised to see that the RVU allocated for 90791 is higher than the RVU allocated for 90792. This indicates that reimbursement for 90792 will be less than the payments for 90791, although the work involved for 90792 will be much higher than that for 90791. So, should we start billing all psychodiagnostic evaluation services as 90791 irrespective of whether or not other evaluation and management (E/M) services were rendered?
Answer: You are right in pointing out that the Relative Value Units (RVUs) allocated to 90791 (Psychiatric diagnostic evaluation) are higher than those allocated for 90792 (Psychiatric diagnostic evaluationwith medical services). CMS has assigned a total RVU of 4.43 to 90791 in the non-facility setting ($150.72 using the 2013 conversion factor), while it has assigned a total RVU of 3.65 to 90792 in the non-facility setting ($124.18 using the 2013 conversion factor). So, as you have pointed out, the reimbursement for 90791 is currently higher than what is being paid out for 90792.
Although practices may consider reporting all psychiatric diagnostic evaluations using 90791 instead of 90792,since 90791 carries a higher pay-out, this would not be appropriate and could possibly invite an audit. Further, if such claims were audited and the documentation showed that you should have billed 90792 rather than 90791, you could be subject to an overpayment request at a minimum and potentially charges of filing false claims or fraud.
There definitely is a mistake in assigning a higher RVU to 90791 in comparison to 90792 considering the work involved. This might get revised at sometime in the future, and when it does, expect the relationship of the two services, in terms of RVUs, to be reversed.
In the meantime, it is better to code as per the guidelines without considering the RVU values of 90791 and 90792.
Tennessee Subscriber
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