Outpatient Facility Coding Alert

Question: What is the difference between 90791 and 90792? Does 90792 reimburse at a higher rate? How often can you use either code? Can we use 90792 and then 90791, or do we have to wait a certain time frame?

New Jersey Subscriber

Answer: When 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, you report 90791 (Psychiatric diagnostic evaluation). This also includes diagnostic tests to work up the diagnoses. This code applies to new patients or to patients undergoing re–evaluation. The RVU for the facility is 3.58 ($128.18) and for non-facility is 3.69 ($132.48).

When 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, you report 90792 (Psychiatric diagnostic evaluation with medical services). The provider may examine and assess the patient’s condition. He may perform lab and imaging tests to evaluate the patient for adverse drug reactions. He may need to do diagnostic tests to conclude the diagnoses. Sometimes he would interview the family members and friends of the patient to make a definite diagnosis. He would then finally prescribe medication and devises the psychosocial comprehensive treatment plan. In addition to this he may refer the patient for psychological, neuropsychological, developmental, or speech, language, and occupation therapy evaluations as a supplement for a full diagnostic evaluation.

This code applies to new patients or to patients undergoing re–evaluation. All these are included in 90792. The RVU for the facility is 3.97 ($142.14) and non-facility 4.09 ($146.44)

Hence 90792 reimburses at a higher rate. You can use both these codes once per day regardless of the number of sessions or amount of time that the provider spends with the patient on the same day.

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