Wiki 90791

[ksinno]

Hello,

I was wondering how often 90791 can be billed out for the same patient on different dates of service?

I did find on CMS that the 90791 is covered once at the onset of an illness or suspected illness.

Is it ok to code a 90791 if a patient is discharged and comes back in for an assessment for a different illness?


Thank you in advance,

KS

 

[jsalzer50]

According to my understanding of the guidelines, you can report 90791 more than once if on different days. And I also believe you can code 90791 for reassessment for different illness after discharge. Specifically, on page 583 in the CPT 2016 Professional Edition, we have:

"Codes 90791, 90792 may be reported more than once for the patient when separate diagnostic evaluations are conducted with the patient and other informants. Report services as being provided to the patient and not the informant or other party in such circumstances."

" 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."

"The psychiatric diagnostic evaluation may include interactive complexity services when factors exist that complicate the delivery of the psychiatric procedure. These services should be reported with add-on code 90785 used in conjunction with the diagnostic psychiatric evaluation codes 90791, 90792."

"Codes 90791, 90792 are used for the diagnostic assessment(s) or reassessment(s), if required, and do not include psychotherapeutic services. Psychotherapy services, including for crisis, may not be reported on the same day." (CPT 2016, pg. 583)