Psychiatry Coding & Reimbursement Alert

Question: Our psychologist recently undertook a fresh psychiatric evaluation of an established patient to ascertain some changes in mental status of the patient. He also conducted a scheduled 30 minute psychotherapy session. Should I report 90832 or +90833 with 90791?

Maryland Subscriber

Answer:  You are not allowed to use either 90832 or the add-on code +90833, nor are you allowed to use any other psychotherapy codes with the psychodiagnostic evaluation code 90791 (Psychiatric diagnostic evaluation) for the same patient on the same calendar date of service.

If you look at CMS guidelines for 90791, it clearly states that this code “cannot be reported with a psychotherapy service code on the same day.” CPT® guidelines also prohibit reporting psychodiagnostic evaluations and psychotherapy on the same day. CPT® guidelines preceding codes 90791 state, “Psychotherapy services, including for crisis, may not be reported on the same day.”

Also, according to Correct Coding Initiative (CCI) edits, psychotherapy codes are bundled into 90791 with the modifier indicator ‘0.’ This modifier indicator tells you that you cannot report psychotherapy codes with 90791 for the same patient on the same date under any circumstances. If you report 90791 with psychotherapy codes, the claim for 90791will be reimbursed and the psychotherapy code will be denied.

Best bet: Your clinician might not be aware that you will not be able to claim for both a psychiatric diagnostic evaluation and a psychotherapy service on the same calendar date. If so, update him on this, so he will not provide both services to the patient on the same calendar date of service. Providing them on separate dates will facilitate receiving payment for both the services.