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90791 for a patient returning after a long hiatus?

V

Viverra

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4
Location
West Valley City, UT
I have been treating this code as if it were the same as the New Patient E/M codes, needing a full 3-year gap between visits. However, after looking a bit closer, I'm not sure that's correct. Is it appropriate to bill this for a patient who returns to our therapy practice after only 2 years? (Presumably the therapist *is* going to be re-evaluating the patient after so long a time).
 
No, 90791 is not restricted the same as E&M codes.

I think its appropriate after 2 years for new episode of illness. Medicare for example allows for same reason

NGS: LCD L33632
CGS: LCD L34353

Comments: This service may be covered once, at the outset of an illness or suspected illness. It may be utilized again for the same patient if a new episode of illness occurs after a hiatus or on admission or readmission to an inpatient status due to complications of the underlying condition. Certain patients, especially children, may require more than one visit for the completion of the initial diagnostic evaluation. The medical record must support the reason for more than one diagnostic interview.
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