Wiki Can 90791 be billed as an e/m code instead?

[maryek28@outlook.com]

My clinic is wanting us to start billing psych evals as an e/m code instead of 90791. Is this appropriate? My view was that since we are supposed to use the code that most accurately describes the service, and there is a specific code for psych evals it wouldn't be appropriate to bill a psych eval as an e/m. I mostly do medical coding so behavioral health coding is not something I have a lot of experience in.

 

[Williamsad78]

I think you have 2 threads in here. This was my answer.
We use for all psych evals 90791 without medical services( ie medications) or 90792 with medical services (ie LABS and/or to review, continue, increase a dose, decrease a dose, add a new medication, or stop a medication). A psych eval can be coded more than once for some payers on an established patient. Example would be the severity putting the patient in the hospital and upon discharge an evaluation is done for additional new diagnosis effecting current and/or change in care. For follow-up visits for medication management only the level of service by MDM 99212-99215, if they provided the additional psychotherapy of 16 or more minutes, I add the add on codes 90833, 90836, or 90838. We are RHC so we use T1015 for APRN-CNP's, and for all LSCW's or LCPC's T1040 (90832, 90834, or 90837 with modifiers AJ, AH, or HO) with the CPT's listed second. We bill the T1015's and T1040's on separate claims.

 

[ckeeney]

I want to add what we do.
90791 - for therapists, social workers, non-medical providers when patient is new to us.
90792 - medical providers if there was medication management when patient is new to us or the medical provider.
Inpatient we use E&M codes for the medical providers: (99221-99239) instead of the 90792. We have our own inpatient unit and do not provide services at general hospitals.
Most payers have restrictions on how often these services can be provided, for example, once every six months or year, unless there is a significant change in the patient's status. There are some other exceptions, you would have to check with your payers.
We use E&M codes for all med management visits other than the initial visit and when 9079X is appropriate as noted.
You don't mention what credential the providers who are doing the 90791 have. I assume it is not therapists, etc who cannot bill E&M services.