90791 & 90792 Denials

[gtrevino1979]

Patient had an initial medication session on 01/05/2023, and then had a follow up session with the same provider on 11/01/2023 and a new initial session with a different provider also on 11/01/2023. Both sessions on the same day were denied. Ideally the follow up session should have been paid at least. Correct? What would be the correct cpt code?

 

[ckeeney]

Check your payer guidelines. Some payers allow 90791 and 90792 only once every 6 or 12 months unless there is a significant change in the patient (new condition, for example) or a different level provider, for example a 90792 done by a medical provider and 90791 by a therapist. Are these all psychiatric evaluations or was the follow-up an E&M medication management visit? Medication management visits are generally E&M codes unless the requirements are met for the psychiatric evaluations. I am not sure what you mean by a "medication session".

 

[Cls1530]

I was just going to say the problem can not be in the same status as it was at the initial visit. If there are not new symptoms, or a new problem then why was the 90791 or 90792 necessary to bill the services. Routine exacerbation would be able to be addressed at 99212-99215.