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Erica Posted Fri 15th of January, 2016 13:37:23 PM

How often can we bill for a 90792?
How long after 90791 can you bill on a 90792? Is there a time frame?

SuperCoder Answered Mon 18th of January, 2016 07:34:41 AM

90792 applies to new patients or to patients undergoing re–evaluation. 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.

When the patient goes for a psychiatric diagnostic evaluation, report either 90791 (Psychiatric diagnostic evaluation) or 90792 (Psychiatric diagnostic evaluation with medical services).

In the past, most payers would allow you to only report one unit of psychiatric diagnostic evaluation code per patient. Now, guidelines have been revised and payers will allow you to claim for more than one unit of 90791 or 90792 if the initial psychiatric diagnostic evaluations extended beyond one session, as long as the sessions are on different dates. An example of this extended evaluation would be when the psychiatrist is evaluating a child and will see the child with the parents and in another session evaluate the child independently. So, depending on medical necessity you can claim for more than one unit of 90791 or 90792 when the psychiatrist performs the evaluation in more than one session spread over more than one day.

When billing for Medicare, CMS will allow only one claim of 90791 or 90792 in a year. However, in some cases, depending on medical necessity, Medicare might allow reimbursement for more than one unit of 90791 or 90792. You can also report these codes when the psychiatrist is seeing the patient after a span of three years.

Code 90792 has a CCI conflict with code 90791. A modifier is not allowed to override this relationship.

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