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90792 vs 99231-99233

  1. #1
    Mountain Home Arkansas
    Question 90792 vs 99231-99233
    Medical Coding Books
    I am brand new to billing psych and I am having a difficult time knowing when to bill 90792 vs 99231-99233. All encounters that I am coding are for inpatient hospital encounters. Per the CPT book, "90792 may be reported once per day" however an article on CPT changes for 2013 published by the APA defines 90792 as an "initial evaluation". Can someone further explain to me the differences between 90792 and 99231-99233 and give some guidelines for determining the appropriate code to bill? Thank you!

  2. Smile psychiatry
    Study the documentation. The requirements for the psych eval differ from those for subseq hospital visits. It should not take many visits to evaluate a psych diagnosis; at some point treatment should begin or be deemed "not medically necessary". I don't visit this site often but I notice many psych related questions don't get answered. By now you should have some direction indicated by denials.
    If anyone has a good source for billing info on neuropsych fellows please advise.

  3. Default 90792
    90792 is for an initial evaluation (initial plan of treatment). So, this would be ok for the first visit that establishes the initial diagnosis and plan of treatment. You could only bill it again if the patient had a new diagnosis and needed a new treatment plan (just as one example). The 99231-99233 is for subsequent hospital visits.

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