Thank you for your reply. Can you please further explain when you would use 99205 in lieu of 90791 for Evaluation?You will need to use the most specific code.
Hello,Generally 90791 is used by therapists because it does not include medical management as a component of the service. Therapists cannot bill 99205 or 90792. It is harder to know when to use 99205 or 90792 since recommended documentation for the 90792 is similar to a 99205/99215; you would have to look at the documentation guidelines to see which is more appropriate. The medical providers where I work do not use the 99205 or 99215 for the initial outpatient visit.
Thank you!From the guidelines "Codes 90791, 90792 may be reported once per day and not on the same day as an evaluation and management service performed by the same individual for the same patient." I would understand this to allow 90791 performed by a therapist as long as the rendering provider is not the same. Payers may have their own rules.