90791 and 90792. PLEASE REPLY THANKS!!

debdebc

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I work in at a fqhc facility and we have a nurse practitioner that will be doing behavioral health. She will not being doing psychotherapy but she will be seeing patients and writing medicines. The 90791 just says for non medical. What can should she be using for first visit and medications and visits thereafter. I appreciate any help!
 
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Since the service does not include psychotherapy, have you considered billing an office E/M code using diagnoses for the condition(s) plus a medication management diagnosis? Rather than digging for a CPT code, find a dx that correctly describes the reason for the visit?
 

ckeeney

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A nurse practitioner may use 90792 if the nurse practitioner is credentialed (not incident to). The documentation for the assessment should be the equivalent of that required for a 99215 psychiatric E/M (97 guidelines). The medical portion of the 90792 is covered by the medication management. To use 90792 make sure you have a behavioral health diagnosis, otherwise use E/M codes for the visit. In behavioral health, medication management uses E/M codes/97 guidelines for billing. There used to be a specific medication management behavioral health CPT, but it was deleted in 2013. I do not know if 90791, 90792 are covered under FQHC rules.
 

thomas7331

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If the service is an initial psychiatric evaluation with medical services, 90792 would be correct - that code does not include psychotherapy. If it is just a medical visit only, then the appropriate E&M code should be used. There are now separate add-on codes for psychotherapy when provided in addition to medical management on the same day.

There is a lot of good information about behavioral health coding that you might find helpful on the APA web site here:

https://www.psychiatry.org/psychiat...edicare-and-medicaid/coding-and-reimbursement

Hope this helps some!
 
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