Psychiatry Coding & Reimbursement Alert

Published on Wed Oct 14, 2015 PDF

Question: I am new to psychiatry coding. Recently, our psychiatrist performed an evaluation of a patient. I am reporting 90792 for this service. After the evaluation of the patient, our clinician spent another 30 minutes interpreting the patient’s details and preparing a report. Since 90792 is not a time based procedure, I was wondering if I can report another code such as 90889 to get compensated for the additional time that our clinician spent in documentation.

Colorado Subscriber

Answer: You report 90792 (Psychiatric diagnostic evaluation with medical services) for initial psychodiagnostic evaluation with medical services. You are right in pointing out that there is no time component attached to either 90792 or for 90791 (Psychiatric diagnostic evaluation). CPT^® guidelines state, “Codes 90791, 90792 may be reported once per day . . . .”

When you report one unit of either 90791 or 90792, it includes the entire time that your clinician spent in reviewing of records, face-to-face time with the patient or the patient’s family members, and the time spent in preparation of a report. So, even though your clinician spent time reviewing records and preparing a report that is not face-to-face time with the patient, this time is factored into the work component of 90791 and 90792 and cannot be reported separately with an additional code.

So, you cannot report the time spent in documentation separately using another CPT^® code such as 90889 (Preparation of report of patient’s psychiatric status, history, treatment, or progress [other than for legal or consultative purposes] for other individuals, agencies, or insurance carriers) to claim separate compensation for this time that your clinician spent.

Note: Most of the payers including Medicare do not provide separate reimbursement for 90889. Instead, they consider payment for this service to be “bundled” in the payment for other services, such as 90791 and 90792. Consistent with this approach, the National Correct Coding Initiative edits bundle 90889 into 90791 and 90792 and do not permit a modifier to override the edits. Some payers might provide payment for this code in certain situations, so you can check with individual payers about the situations in which you will receive payment for this code. For instance, you can sometimes charge for preparation of a report to the patient if the report is being used for the benefit of the patient in a legal situation. As noted in the code descriptor, code 90889 is for use when preparing a report for some other individual’s or entity’s benefit, not for the physician’s own documentation purposes.