Question 90792 vs 99201-99205

herouxm

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"...90792 may be reported more than once for the patient when separate diagnostic evaluations are conducted with patient and other informants." Does this same rule apply if the psychiatrist chooses to report a new patient e/m code?
 

Chelle-Lynn

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Code 90791 and 90792 reports a psychiatric diagnostic interview exam including a complete medical and psychiatric history, a mental status exam, ordering of laboratory and other diagnostic studies with interpretation, and communication with other sources or informants. What E&M would the Psychiatrist be billing in addition to the 90791 or 90792?
 

Chelle-Lynn

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If the psychiatrist is billing an 99204 or 99205 then they could not bill a 90792 as there is a CCI edit for these two codes that does not allow for any modifier.
 

herouxm

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What about the 3 year rule regarding new patients. If one episode of care ends in 12 months but the client needs to return 12 months later, can the psychiatrist bill another 99204 99205 for a new psych eval for this second episode of care? Thanks for your, much appreciated!
 

kdlberg

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If the patient received any care from that provider within 3 years, they are not a new patient--even if they have a new problem that requires starting the work up from scratch.
 

Chelle-Lynn

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90792 is not subject to the 3 year rule as for example the 99211-99215 are. The diagnostic interview exam is done when the provider first sees a patient, but may also be utilized again for a new episode of illness, or for re-admission as an inpatient due to underlying complications.
 
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