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Wiki 90791 & 90792 Denials

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gtrevino1979

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San Antonio, TX
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Patient had an initial medication session on 01/05/2023, and then had a follow up session with the same provider on 11/01/2023 and a new initial session with a different provider also on 11/01/2023. Both sessions on the same day were denied. Ideally the follow up session should have been paid at least. Correct? What would be the correct cpt code?
 
Check your payer guidelines. Some payers allow 90791 and 90792 only once every 6 or 12 months unless there is a significant change in the patient (new condition, for example) or a different level provider, for example a 90792 done by a medical provider and 90791 by a therapist. Are these all psychiatric evaluations or was the follow-up an E&M medication management visit? Medication management visits are generally E&M codes unless the requirements are met for the psychiatric evaluations. I am not sure what you mean by a "medication session".
 
I was just going to say the problem can not be in the same status as it was at the initial visit. If there are not new symptoms, or a new problem then why was the 90791 or 90792 necessary to bill the services. Routine exacerbation would be able to be addressed at 99212-99215.
 
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