90791/90792 Evaluation as Opposed to Outpatient 99205

[tamstrnd]

Can someone please tell me if I can use Outpatient E/M 99205 as opposed to 90791/90792 Evaluation Codes?

Your help and time is greatly appreciated!

Tammy

 

[SharonCollachi]

You will need to use the most specific code.

 

[tamstrnd]

You will need to use the most specific code.

Thank you for your reply. Can you please further explain when you would use 99205 in lieu of 90791 for Evaluation?

 

[ckeeney]

Generally 90791 is used by therapists because it does not include medical management as a component of the service. Therapists cannot bill 99205 or 90792. It is harder to know when to use 99205 or 90792 since recommended documentation for the 90792 is similar to a 99205/99215; you would have to look at the documentation guidelines to see which is more appropriate. The medical providers where I work do not use the 99205 or 99215 for the initial outpatient visit.

 

[spalac4@wgu.edu]

Generally 90791 is used by therapists because it does not include medical management as a component of the service. Therapists cannot bill 99205 or 90792. It is harder to know when to use 99205 or 90792 since recommended documentation for the 90792 is similar to a 99205/99215; you would have to look at the documentation guidelines to see which is more appropriate. The medical providers where I work do not use the 99205 or 99215 for the initial outpatient visit.

Hello,

Could you help me with a question. I understand that 90791 cannot be billed in conjunction with an e/m by the same individual. Does that mean all the providers in the same office? or just an individual? We have an LCDC billing 90791 and the MD is billing an E/M on the same date of service. Is this allow?

 

[ckeeney]

From the guidelines "Codes 90791, 90792 may be reported once per day and not on the same day as an evaluation and management service performed by the same individual for the same patient." I would understand this to allow 90791 performed by a therapist as long as the rendering provider is not the same. Payers may have their own rules.

 

[spalac4@wgu.edu]

From the guidelines "Codes 90791, 90792 may be reported once per day and not on the same day as an evaluation and management service performed by the same individual for the same patient." I would understand this to allow 90791 performed by a therapist as long as the rendering provider is not the same. Payers may have their own rules.

Thank you!