Wiki 90791 Billing

[celcano]

Good afternoon, All,
I see where this question was posted once before, but I don't see where anyone ever responded to it. We have now had this happen in our Pain Management practice and I'm not quite sure how we bill it. Here is the original question:

'We have a pt that came in for an assessment but was not able to finish on this day she came back a couple days later to finish the assessment. Are we able to bill 90791 for both days or can we only bill one 90791 and if so does it matter which day we bill this on?"

Also, if you can't bill 90791 for the return visit, what code do you bill?

Any input would be greatly appreciated.

Thank You!

 

[Skymom]

Typically, billing is submitted for the date the service was completed.

Most insurance companies will not allow two 90791 services in a short period of time, but there may be an insurance policy here or there that allows this. (Optum EAP allows this with pre-authorization, but I don't know of any others.)

How much of the procedure was completed the first visit and what was the reason that the eval could not be completed? If the patient became combative, non-communicative, or some other extraordinary circumstance occurred that impeded the process (parent and child fighting during the session, for example), interactive complexity add-on might be warranted. If the eval was unable to be started and the session really fits the requirements of some other type of service (90832, for example), then that would be billed instead. Documentation must thoroughly support the billing of the charge.

Obviously, since 90791 is not time-based, it is not OK to bill another code just to be paid for the time.

 

[celcano]

Thank you for the reply. It makes perfect sense.