Psychiatry Coding & Reimbursement Alert

Published on Fri Jul 08, 2016 PDF

Question: Is it possible for a patient to have a psychodiagnostic evaluation (90791) and an E/M service on the same calendar date of service if these services were performed by two different clinicians?

Minnesota Subscriber

Answer: If you look at code specific guidelines for psychodiagnostic evaluation code 90791 (Psychiatric diagnostic evaluation), you will see that it instructs you not to report 90791 in conjunction with E/M codes on the same calendar date of service.

Also, if you look at Correct Coding Initiative (CCI) edits, you will see that there is an edit bundle between E/M codes and psychodiagnostic evaluation code 90791. According to these edits, E/M codes are bundled into 90791 with the modifier indicator ‘0,’ which means you cannot report these two codes for the same patient on the same calendar date of service. Since the modifier indicator is ‘0,’ you cannot overcome the edit bundle using a modifier.

These edits typically apply if you are reporting both these services for the patient on the same claim form or, in other words, when the services are being provided by one clinician or by two clinicians billing under a common provider identification number (e.g. a group number). In your case, the services in question are being provided by two different providers. If two different providers are performing the two different services and those providers do not bill under a common provider identification number, you can report 90791 and the E/M code on two different claim forms, under each of the respective clinicians using their individual National Provider Identifier (NPI) numbers.

Remember: Even though two different clinicians are performing the services and these services should be payable if they are claimed separately, it is still best to check with the payer to see if its guidelines permit payment for both of the services and thereby avoid the risk of denials.