Wiki Psych Diagnostic Eval with an ED visit

Psych Eval & ED E/M

From the auditing perspective, for the psych eval, I'd look at 90792, psychiatric diagnostic evaluation with medical services (without the E/M as this code includes assessment and treatment). For the other, I would expect to see an ED E/M as it isn't generally medically necessary for 2 separate practitioners to provide 2 separate psych evals on the same DOS unless the documentation fully supports the need for the duplicative service.This is a nice reference page for psychiatric codes.
 
90791 help please

hello, i am in the behavioral health field and we have been all going back and forth on the 90791 on whom can bill this code. i found info that states the following:


"A 90791 and 90792 is only billable when provided by physicians (DO’s, MD’s), Clinical social workers (CSW), clinical psychologists (CP’s), clinical nurse specialists (CNS’s), physician assistants and nurse practitioners when the services performed are within the scope of their clinical practice/education and authorized under the state law.


*CPT Codes 90791 and 90792 may be billed once per day. However, only one code may be billed by the same provider daily. If 90792 and 90791 are billed on the same day, by the same individual provider, 90791 will be denied. Additionally, evaluation and management, psychotherapy (90834 and 90837), and crisis management services may not be billed by the same provider on the same day as a psychiatric diagnostic evaluation. Claim submissions not in compliance with this rule will be denied.

however, in the past we have had insurance companies send fee schedules allowing this code to be billed by a LCSW or LMHC... i need help , this is getting really confusing
 
Lmhc?

Hello Zinia,

Did you ever receive clarification is a LMHC could perform 90791? I'm running into this issue now.

Thank you for your time!

Autumn
 
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