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Requirements for 90791

hmacinski

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Does anyone have any information about 90791, for instance can it be done over the phone, is there any time frames for how often it can be completed or is appropriate to be complete in a opioid addiction recovery program? Any information would be helpful.
 

kathrynw

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This is what I've found for code 90791.

The 2019 CPT book lists a star next to this code. If you look under code symbols the star designates a telemedicine code.

The lay terms for 90971 are as followed:
In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.
Clinical Responsibility
The provider performs a diagnostic evaluation that includes collecting information about present and past behavior concerns as well as past family, medical, and social history. He also performs diagnostic tests to work up the diagnoses. This code applies to new patients or to patients undergoing re–evaluation.
Tips
Use this code only once per day regardless of the number of sessions or time that the provider spends with the patient on the same day.



It might also be helpful to review the range specific guidelines for this CPT code.
Range Specific Guideline
Psychiatric diagnostic evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies.
Psychiatric diagnostic evaluation with medical services is an integrated biopsychosocial and medical assessment, including history, mental status, other physical examination elements as indicated, and recommendations. The evaluation may include communication with family or other sources, prescription of medications, and review and ordering of laboratory or other diagnostic studies.
In certain circumstances one or more other informants (family members, guardians, or significant others) may be seen in lieu of the patient. 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.
(Do not report 90791-90899 in conjunction with 90839, 90840, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T)


Hopefully this helps.
 
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