Wiki CPT 90791

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beckmanj

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One of our Psychiatrist left and we have a new one. The patients of that provider are being distributed to the new one and the other 2 established ones. Since these providers have not seen these patients before can they bill 90791 when they first see the patient?

Jane
 
If you check the description of a new patient that is in the CPT book, you'll find that in a group practice (all under one tax ID), all of the same specialists are treated as one person. So no, they are not a new patient to the practice, and therefore not new to the psychiatrist.

If they are all individual providers, NOT in a group practice, then they would bill as new patients.
 
Hello, I am an auditor for behavioral health. I believe that the "new patient" as defined within the E/M codes does not apply to the psychiatric code 90791. Per the guidelines for the 90791 code "Codes 90791 and 90792 are used for the diagnostic assessment(s) or reassessment(s), if required,", the guidelines do not define how often this code should be billed other than as clinically appropriate. However, certain payers may limit the use of the code to once per year per patient or have other restrictions, so you should inquire with the patient's payers in this situation as to if they will pay for the code if it is found to be clinically appropriate to repeat the assessment in the circumstance you describe. Hope that helps!
 
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