In the field of mental health care, accurate diagnosis is essential for effective treatment. One important tool in the diagnostic process is the CPT Code 90792, which is used for psychiatric diagnostic evaluations. To ensure that you are properly billing for this code and maximizing reimbursem*nt, it is crucial to understand the requirements, license level, and reimbursem*nt rates associated with CPT Code 90792.
Key Takeaways:
- CPT Code 90792 is used for psychiatric diagnostic evaluations in mental health care.
- It involves eliciting complete medical and psychiatric history, conducting a mental status examination, establishing an initial diagnosis, and evaluating the patient’s ability to respond to treatment.
- The reimbursem*nt rates for CPT Code 90792 vary and it’s important to check with individual insurance payers.
- Only licensed medical professionals can perform CPT Code 90792.
- Additional add-on codes and billing modifiers may be applicable when using CPT Code 90792.
What is CPT Code 90792?
CPT Code 90792 is a Psychiatric Diagnosis Interview Examination performed by a licensed mental health provider. This code is used when conducting comprehensive psychiatric evaluations to assess patients’ mental health and determine appropriate treatment plans.
During the psychiatric diagnosis interview, the healthcare professional elicits the patient’s complete medical and psychiatric history. This includes information about their past and present symptoms, medical conditions, medications, and any previous psychiatric treatments. The interview helps in understanding the context of the patient’s mental health and identifying relevant factors that may contribute to their condition.
As part of the examination, a mental status examination is conducted to assess the patient’s cognition, emotions, and overall mental functioning. This involves evaluating their appearance, behavior, thought processes, memory, and attention span. The mental status examination helps in identifying potential mental disorders and understanding the patient’s current psychological state.
Based on the gathered information, the healthcare provider establishes an initial diagnosis, which involves identifying and classifying the patient’s mental health condition according to recognized diagnostic criteria. This diagnosis serves as the foundation for developing an appropriate treatment plan.
Additionally, the psychiatric diagnosis interview examination includes an evaluation of the patient’s ability to respond to treatment. This assessment helps determine the patient’s readiness to engage in therapy and their potential for improvement.
Please note that CPT Code 90792 cannot be billed on the same day as Evaluation and Management services performed by the same provider. It is important to ensure proper coding and billing practices to accurately reflect the services provided during the psychiatric diagnosis interview.
Reimbursem*nt Rates for CPT Code 90792
The reimbursem*nt rates for CPT Code 90792 can vary based on the year and insurance provider. It is essential to stay informed about the reimbursem*nt rates to ensure accurate billing and appropriate compensation for psychiatric evaluations.
For 2023, the Medicare reimbursem*nt rate for CPT Code 90792 is $196.55. Medicare sets the standard reimbursem*nt rates used by many insurance companies as a benchmark. However, it is important to note that different insurance payers may have their own specific reimbursem*nt rates, which can vary from the Medicare rates.
In order to receive accurate reimbursem*nt, it is crucial to check with individual insurance payers, such as private insurance companies or Medicaid, to determine their specific reimbursem*nt rates for CPT Code 90792. This information can be obtained through the insurance payer’s fee schedule or by contacting their billing department or provider services.
| Insurance Payer | Reimbursem*nt Rate |
|---|---|
| Medicare | $196.55 |
| Private Insurance A | $220.00 |
| Private Insurance B | $180.75 |
| Medicaid | $160.25 |
Time Length for CPT Code 90792
When it comes to the time length for CPT Code 90792, it’s important to note that the duration of a medical assessment and diagnostic interview is not coded by time itself. Instead, this code represents a comprehensive evaluation and examination conducted by mental health providers.
However, in practice, providers generally allocate a minimum of 60 to 120 minutes to complete the evaluation and examination required for CPT Code 90792. This allows for a thorough assessment of the patient’s medical and psychiatric history, as well as a comprehensive mental status examination.
During this time, the mental health provider will delve into the patient’s background and symptoms, evaluate their ability to respond to treatment, and establish an initial diagnosis. This extended duration allows for a comprehensive understanding of the patient’s mental health and facilitates the development of an appropriate treatment plan.
It’s important for providers to allocate sufficient time for the evaluation and examination to ensure accurate diagnoses and proper patient care. By dedicating a significant amount of time to this process, mental health professionals can effectively assess and address the unique needs of their patients.
Key Takeaways:
- CPT Code 90792 does not have a specified time length, but providers typically require a minimum of 60 to 120 minutes to complete the assessment and examination.
- This extended duration allows for a comprehensive evaluation of the patient’s medical and psychiatric history, as well as a thorough mental status examination.
- Adequate time is crucial for accurately diagnosing patients and developing appropriate treatment plans.
License Level Requirements for CPT Code 90792
CPT Code 90792 is a specialized psychiatric diagnostic evaluation that must be performed by licensed medical professionals. In order to bill for this code, providers must meet certain license requirements to ensure the safety and quality of mental health care.
The licensed medical professionals eligible to perform CPT Code 90792 include:
- Psychiatrists: Psychiatrists are medical doctors (MD) or doctors of osteopathic medicine (DO) with specialized training in mental health disorders. They are qualified to conduct comprehensive psychiatric evaluations and provide accurate diagnoses.
- Physicians: Physicians who have obtained an MD or DO degree can also perform CPT Code 90792. While their primary focus may not be mental health, they have the necessary medical background to conduct psychiatric assessments and evaluations.
It is important to note that non-MD mental health providers, such as psychologists, social workers, and counselors, should use a different CPT code, specifically CPT Code 90791, for their claims. This code covers diagnostic evaluations performed by non-physician mental health professionals.
By ensuring that only licensed medical professionals perform CPT Code 90792, we can uphold the highest standards of psychiatric care and ensure that patients receive accurate diagnoses and appropriate treatment plans.
Add-On Codes for CPT Code 90792
Alongside CPT Code 90792, there are several add-on codes that can be utilized to accurately represent the complexity and additional services associated with psychiatric evaluations. These add-on codes offer a comprehensive framework for capturing interactive complexity and supplementary services provided during the diagnostic interview and evaluation.
Interactive Complexity: 90785
To account for the intricacies of certain psychiatric evaluations, an add-on code known as 90785 can be used. Interactive complexity refers to cases that involve communication challenges due to factors such as a patient’s non-verbal behavior, intellectual impairments, or emotional/behavioral issues. The interactive complexity add-on code provides proper documentation and reimbursem*nt for the additional time and cognitive effort required to manage these complexities.
Additional Services: 90833, 90836, 90863, 99050, and 99051
In conjunction with the diagnostic interview and evaluation for CPT Code 90792, healthcare professionals may also provide additional services that warrant separate coding. The following add-on codes can be used to accurately capture these supplementary services:
| Add-On Code | Service Description |
|---|---|
| 90833 | Psychotherapy, 30 minutes with patient |
| 90836 | Psychotherapy, 45 minutes with patient |
| 90863 | Pharmacologic management, including prescription and review of medication |
| 99050 | Services provided in the office at times other than regularly scheduled office hours |
| 99051 | Services provided in the office during regularly scheduled evening, weekend, or holiday office hours |
Each of these add-on codes plays a crucial role in accurately documenting and coding for the additional services provided alongside the diagnostic evaluation. By utilizing these codes appropriately, healthcare providers can ensure proper documentation and reimbursem*nt for their services.
Billing Modifiers for CPT Code 90792
When billing for CPT Code 90792, it is essential to use the appropriate billing modifiers to indicate the type of clinician providing the service. Properly identifying the provider type ensures accurate reimbursem*nt and compliance with billing regulations.
Here are the billing modifiers commonly used for CPT Code 90792:
| Billing Modifier | Provider Type |
|---|---|
| AJ | Clinical Social Worker |
| AF | Psychiatrist |
| AH or HP | Clinical Psychologist or Doctor with a Doctorate-level Degree |
Using the correct billing modifier informs the payer about the level and qualifications of the provider rendering the services. For example, if a clinical social worker is the provider, the billing modifier AJ should be used. On the other hand, if a psychiatrist is the provider, the billing modifier AF is appropriate.
It is crucial to select the appropriate billing modifier based on the provider’s qualifications. Failing to use the correct modifier may result in claim denials or delayed reimbursem*nts.
Remember to consult the specific guidelines and requirements of individual payers to ensure compliance when using billing modifiers for CPT Code 90792.
How to Bill CPT Code 90792
When it comes to billing for CPT Code 90792, there are specific guidelines and requirements that need to be followed. To ensure accurate and efficient billing, it’s important to understand the process and the necessary steps involved.
The first step in billing for CPT Code 90792 is to complete the CMS-1500 form. This standard form is used for submitting claims for healthcare services and is recognized by most insurance payers. When filling out the form, the CPT code should be added to line 24, which is specifically designated for the procedure code.
It’s crucial to accurately enter the CPT code to avoid any delays or denials in the reimbursem*nt process. The code should be entered exactly as “90792” to ensure proper identification of the psychiatric evaluation service being provided.
Additionally, it’s essential to follow the specific billing guidelines and requirements set forth by individual insurance payers. Different insurance companies may have their own rules and regulations regarding the documentation and submission of claims. Familiarizing yourself with these guidelines will help streamline the billing process and increase the chances of reimbursem*nt.
By adhering to the appropriate billing procedures and guidelines, mental health providers can ensure proper reimbursem*nt for their services and maintain compliance with insurance payers.
| Steps to Bill CPT Code 90792 |
|---|
| Complete the CMS-1500 form |
| Add the CPT code to line 24 of the form |
| Follow the specific billing guidelines of individual insurance payers |
Introduction to CPT Coding
The Current Procedural Terminology (CPT) coding system, published by the American Medical Association (AMA) in 1966, provides a comprehensive and standardized language for describing medical and surgical procedures as well as diagnostic services.
At its core, the CPT coding system ensures accurate communication between healthcare providers, insurers, and other stakeholders involved in patient care. It establishes a common framework for documenting and reporting medical procedures, facilitating accurate billing, reimbursem*nt, and data analysis.
By assigning specific codes to medical procedures and services, the CPT coding system enables efficient and consistent record-keeping and streamlines administrative processes within the healthcare industry. These codes play a crucial role in facilitating the transfer of information across various healthcare settings and systems.
The CPT coding system has undergone regular updates and revisions to reflect advancements in medical practice and technology. With over 10,000 codes, it encompasses a wide range of medical specialties and fields, ensuring that healthcare professionals can accurately document and report the services they provide.
The Benefits of CPT Coding
Implementing the CPT coding system offers several benefits to healthcare providers, insurers, and patients alike:
- Standardization: CPT codes enable consistent communication and understanding of medical procedures and services, reducing confusion and potential errors.
- Accuracy: By assigning specific codes to each procedure, healthcare professionals can accurately document and report the services provided, ensuring proper reimbursem*nt and data analysis.
- Efficiency: The use of standardized codes streamlines administrative processes, such as billing and claims processing, saving time and reducing administrative burden.
- Insurance Coverage: CPT coding is essential for determining insurance coverage and ensuring fair reimbursem*nt for healthcare services.
- Research and Analysis: The data collected through the CPT coding system allows for comprehensive analysis of healthcare trends, outcomes, and costs.
Overall, the CPT coding system plays a vital role in the healthcare industry by promoting accuracy, efficiency, and standardized communication among healthcare providers, insurers, and regulatory bodies.
| CPT Coding System Overview | Year Published | Leading Organization |
|---|---|---|
| CPT Coding System | 1966 | American Medical Association (AMA) |
How Is the CPT Manual Organized?
The CPT manual is organized in a user-friendly manner, ensuring easy navigation and accessibility to the vast array of medical procedures and services it encompasses. Let’s take a closer look at the organization of the CPT manual:
An Introduction
The CPT manual begins with an introduction section that provides an overview of the coding system, its purpose, and how it is used in medical billing and documentation.
Illustrated Anatomical and Procedural Review
Following the introduction, the manual includes an illustrated anatomical and procedural review section. This section offers visual aids and descriptions of the human body’s anatomical structures and identifies key procedural terms and concepts.
Major Clinical Sections
The major clinical sections form the core of the CPT manual, providing detailed information on various medical specialties and procedures. These sections encompass a wide range of disciplines, including but not limited to:
- Medicine
- Surgery
- Radiology
- Anesthesiology
- Pathology and Laboratory
- Evaluation and Management
Each clinical section is organized with a numerical range of codes specific to the procedures and services within that specialty. For example, psychiatry codes can be found in the Psychiatry subsection of the Medicine section.
Category II and III Codes
The CPT manual also includes Category II and III codes. Category II codes are supplemental codes that facilitate performance measurement and tracking of outcomes by providing additional data points related to the procedures or services rendered. Category III codes, on the other hand, are temporary codes used for emerging services and procedures that are still undergoing evaluation.
Appendixes and an Index
Furthermore, the CPT manual contains appendixes that serve as important reference materials, including modifiers, clinical examples, and summaries of code changes. These appendixes provide additional context and clarification for the codes and their proper usage. Additionally, an extensive alphabetical index is available to facilitate quick and efficient searches for specific codes and terms.
The organized structure of the CPT manual ensures that medical professionals and coders can readily access the relevant codes and guidelines they need to accurately document, bill, and communicate medical procedures and services.
| CPT Manual Organization | Contents |
|---|---|
| Introduction | An overview of the coding system and its purpose |
| Illustrated Anatomical and Procedural Review | Visual aids and descriptions of anatomical structures and procedural terms |
| Major Clinical Sections | Specialized sections for different medical specialties and procedures |
| Category II and III Codes | Supplemental codes for performance measurement and emerging services |
| Appendixes | Additional reference materials, such as modifiers and code change summaries |
| Index | An alphabetical index for quick code and term look-up |
Psychiatry Codes in the CPT Manual
For psychiatrists, the relevant codes can be found in the Psychiatry subsection of the Medicine section in the CPT Manual. These codes cover most of the services provided by mental health professionals in both inpatient and outpatient settings.
Psychiatrists play a crucial role in diagnosing and treating mental health conditions. To accurately document and bill for their services, it is important for psychiatrists to understand the specific codes and guidelines outlined in the CPT Manual.
The Psychiatry subsection of the CPT Manual provides a comprehensive list of codes that are relevant to psychiatric evaluations, diagnostic procedures, psychotherapy sessions, and other mental health services. These codes are used to convey the specific procedures or services provided to insurance companies for reimbursem*nt purposes.
Psychiatry codes are typically in the format of 908xx, with each code representing a specific mental health service. The range of 908xx codes covers various aspects of psychiatric care, including initial evaluations, follow-up visits, and psychotherapy sessions.
When selecting the appropriate code from the Psychiatry subsection, psychiatrists need to consider factors such as the level of evaluation or therapy provided, the duration of the session, and any additional services or complexities involved in the treatment process.
Here is a table highlighting some commonly used psychiatry codes and their corresponding services:
| Code | Service |
|---|---|
| 90832 | Individual psychotherapy, 30 minutes |
| 90839 | Psychotherapy for crisis, 60 minutes |
| 90847 | Family psychotherapy (with patient present), 50 minutes |
| 90853 | Group psychotherapy |
It is important for psychiatrists to accurately assign the appropriate code based on the services provided to ensure proper reimbursem*nt and documentation. The CPT Manual provides detailed descriptions for each code, assisting psychiatrists in selecting the correct code for their specific services.
By using the psychiatry codes outlined in the CPT Manual, psychiatrists can effectively communicate the nature of their services and ensure accurate billing and reimbursem*nt for mental health treatments.
Changes to Psychiatry Codes
In recent years, there have been significant changes to the psychiatry codes that healthcare providers need to be aware of. These changes aim to streamline and improve the coding process for psychiatric evaluations and psychotherapy services. Let’s explore two important updates: the distinction between initial evaluations with and without medical services, and the simplification of psychotherapy codes.
Initial Evaluation with Medical Services
One of the key changes in psychiatry codes is the introduction of a separate code for initial evaluations that involve medical services. This is where the CPT code 90792 comes into play. It is used to bill for an initial diagnostic evaluation that includes a comprehensive assessment of both the patient’s psychiatric and medical conditions.
Previously, there was no specific code to differentiate between initial evaluations with or without medical services. This distinction is crucial as it allows providers to capture the comprehensive nature of the evaluation and the additional time and expertise required to assess the patient’s medical and psychiatric needs concurrently.
Simplification of Psychotherapy Codes
Another significant change in psychiatry codes is the simplification of psychotherapy codes. Psychotherapy is a vital component of mental health treatment, and these revised codes aim to accurately capture the variety of psychotherapy services provided to patients.
The new psychotherapy codes eliminate the need for separate codes based on the duration of the session. Instead, a single code, CPT 90834, is used for individual psychotherapy sessions that last 45 to 50 minutes, while CPT 90837 is used for sessions that last 60 minutes or longer.
By reducing the number of codes and focusing on the duration of the session, these changes aim to simplify the coding process and ensure accurate billing for psychotherapy services.
Summary of Changes
To summarize the changes to psychiatry codes:
- The introduction of CPT code 90792 for initial evaluations with medical services
- The simplification of psychotherapy codes with a focus on session duration
These changes reflect the evolving landscape of psychiatry and the importance of accurately documenting and billing for services provided. It is crucial for healthcare providers to stay updated with these code changes to ensure proper reimbursem*nt and compliance with coding guidelines.
Category II and III Codes
The CPT manual includes supplemental Category II and III codes that provide additional information and classification for specific services and procedures.
Category II codes are used for performance measurement and tracking of medical procedures and services. These codes are optional and can be used to indicate adherence to quality measures, patient outcomes, and other performance indicators.
Category III codes, on the other hand, are temporary codes used for emerging technologies, procedures, and services. They are designed to facilitate data collection and assessment to determine the effectiveness and safety of these emerging practices.
Category II and III codes help enhance coding accuracy, streamline data reporting, and improve healthcare delivery and outcomes.
| Category II Codes | Category III Codes |
|---|---|
| Codes used for performance measurement and tracking | Temporary codes for emerging services and procedures |
| Optional use | Used to collect data for assessment and evaluation |
| Help in improving quality of care and patient outcomes | Aids in evaluating emerging technologies and procedures |
Appendixes and Index
In addition to the main content, the CPT manual includes appendixes and an alphabetical index to enhance the usability and comprehensiveness of the coding system. These resources provide valuable supplementary information to assist in accurate coding and reference.
Appendixes
The appendixes in the CPT manual offer additional details and guidelines to support proper coding practices. They cover various aspects of the coding process, such as modifiers, clinical examples, and summaries of code changes.
Here is an overview of the appendixes found in the CPT manual:
- Appendix A: Modifiers
- Appendix B: Summary of Additions, Deletions, and Revisions
- Appendix C: Clinical Examples
- Appendix D: Summary of CPT Codes Exempt from Modifier 51 Reporting
- Appendix E: Category II Codes
- Appendix F: Category III Codes
- Appendix G: Summary of CPT Codes that Include Moderate (Conscious) Sedation
These appendixes provide valuable information to help clarify coding concepts, address specific scenarios, and ensure accurate documentation.
Alphabetical Index
The CPT manual includes an extensive alphabetical index that allows for easy reference and navigation. This index contains an organized, comprehensive list of terms, procedures, and codes, enabling users to quickly locate the relevant sections within the manual.
The alphabetical index is a valuable tool for efficiency in searching for and identifying the appropriate codes for specific medical procedures and services.
Appendix | Code |
|---|---|
| Appendix A: Modifiers | 2 |
| Appendix B: Summary of Additions, Deletions, and Revisions | 6 |
| Appendix C: Clinical Examples | 12 |
| Appendix D: Summary of CPT Codes Exempt from Modifier 51 Reporting | 18 |
| Appendix E: Category II Codes | 22 |
| Appendix F: Category III Codes | 29 |
| Appendix G: Summary of CPT Codes that Include Moderate (Conscious) Sedation | 35 |
These appendixes and the alphabetical index serve as valuable resources for medical professionals, ensuring accurate coding, streamlined documentation, and efficient billing processes.
Conclusion
Understanding CPT Code 90792 is crucial for conducting psychiatric evaluations and ensuring accurate billing for these services. By following the specific guidelines and requirements outlined in the CPT manual, healthcare professionals can effectively navigate the complexities of psychiatric diagnostic evaluations.
CPT Code 90792 allows licensed mental health providers to perform a comprehensive psychiatric diagnostic evaluation, including eliciting complete medical and psychiatric history, conducting a mental status examination, establishing an initial diagnosis, and evaluating the patient’s ability to respond to treatment. It is important to stay updated on any changes to the code, as well as the reimbursem*nt rates set by individual insurance payers.
When using CPT Code 90792, it is essential to adhere to the license level requirements. Only licensed medical professionals, such as psychiatrists and physicians with an MD or DO degree, are eligible to bill for this code. Non-MD mental health providers should utilize CPT Code 90791 for their claims.
In conclusion, by understanding and correctly utilizing CPT Code 90792, healthcare professionals can ensure accurate billing for psychiatric evaluations and provide comprehensive care to patients seeking mental health assessment and treatment.
FAQ
What is CPT Code 90792?
CPT Code 90792 is a Psychiatric Diagnosis Interview Examination performed by a licensed mental health provider. It involves eliciting complete medical and psychiatric history, conducting a mental status examination, establishing an initial diagnosis, and evaluating the patient’s ability to respond to treatment.
What are the reimbursem*nt rates for CPT Code 90792?
The reimbursem*nt rates for CPT Code 90792 vary depending on the year. For 2023, the Medicare reimbursem*nt rate is 6.55. It is important to check with individual insurance payers for specific reimbursem*nt rates.
How long does a medical assessment and diagnostic interview for CPT Code 90792 take?
The duration of a medical assessment and diagnostic interview for CPT Code 90792 is not coded by time. However, providers generally require a minimum of 60 to 120 minutes to complete the evaluation and examination.
Who can perform CPT Code 90792?
CPT Code 90792 can only be performed by licensed medical professionals. This includes psychiatrists and physicians who have obtained an MD or DO degree. Non-MD mental health providers should use CPT Code 90791 for their claims.
Are there any add-on codes for CPT Code 90792?
Yes, there are several add-on codes that can be used with CPT Code 90792, including 90785 for interactive complexity and 90833, 90836, 90863, 99050, 99051 for additional services provided in conjunction with the diagnostic interview and evaluation.
What billing modifiers should be used for CPT Code 90792?
When billing for CPT Code 90792, it is important to use the appropriate billing modifiers to indicate the type of clinician providing the service. For example, AJ is used for clinical social workers, AF for psychiatrists, and AH or HP for clinical psychologists or doctors with a doctorate-level degree.
How should CPT Code 90792 be billed?
When billing for CPT Code 90792, it should be added to line 24 on the CMS-1500 form. It is important to follow the specific billing guidelines and requirements of individual insurance payers.
What is the CPT coding system?
The Current Procedural Terminology (CPT) coding system was first published by the American Medical Association (AMA) in 1966. It provides a uniform language for describing medical and surgical procedures and diagnostic services.
How is the CPT manual organized?
The CPT manual is organized to be user-friendly, with sections dedicated to different types of procedures and services. It includes an introduction, illustrated anatomical and procedural review, major clinical sections, category II and III codes, appendixes, and an index.
Where can I find psychiatry codes in the CPT manual?
For psychiatrists, the relevant codes can be found in the Psychiatry subsection of the Medicine section in the CPT Manual. These codes cover most of the services provided by mental health professionals in both inpatient and outpatient settings.
Have there been any changes to psychiatry codes?
Yes, there have been major changes to the psychiatry codes, including the distinction between an initial evaluation with medical services (90792) and an initial evaluation without medical services (90791). The psychotherapy codes have also been simplified.
What are Category II and III codes in the CPT manual?
The CPT manual includes supplemental Category II and III codes. Category II codes are used for performance measurement, while Category III codes are temporary codes used for emerging services and procedures.
What additional information does the CPT manual provide?
The CPT manual includes appendixes with additional information, such as modifiers, clinical examples, and summaries of code changes. It also includes an extensive alphabetical index for easy reference.
Why is it important to understand CPT Code 90792?
Understanding CPT Code 90792 is crucial for conducting psychiatric evaluations and billing for these services. It is important to follow the specific guidelines and requirements set forth in the CPT manual and to stay updated on any changes to the codes.
