Wiki 90792 + 90833 Illinois

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mc1030

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Hi Everyone,

I am in Illinois billing/coding for a BH practice. I have a therapist that is using these two codes together but we had to explain that it isn’t a compatible add-on code. I explained that the only add-on that want can be use is the interactive complexity code but it’s only for increased complex, not time. The therapist misunderstood and is thinking it is for prolonged time. Is there another add on code that is compatible with 90792 that explains he went over 60 mins? I have searched online and saw something that says that is the minimum for the 90792 code is 60 mins & can exceeds up to 120 mins. I just need come clarification on this cause I keep seeing multiple of answers that are different and want to make sure I bill the therapist correctly!
 
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I think all of this depends on what they are performing and documenting. Is the provider performing a medical evaluation with the diagnostic eval? I think we would have to know what exactly the documentation states and what the service is to figure out what is going on. Are they performing psychotherapy, a psychiatric diagnostic eval, a psychiatric diagnostic eval with medical services, an evaluation and management service, etc.?
If you (or have the therapist) read the CPT book Psychiatric Diagnostic Procedures section, psychotherapy services may not be reported on the same day as 90791 or 90792. 90791 & 90792 are also not time based codes. 90792 is a once per day code. I would also suggest reading the CPT section for 90785. Sounds like they are confused about coding/billing their services.


What you saw is that due to the nature of the service, it would be expected 90791 or 90792 would take anywhere from 60-120 minutes because they involve that much time and effort to gather information and make diagnostic decisions. So, while not a time-based code, it would be expected that it would take that long and some payers may be looking for that. Just because it took more than 60 minutes doesn't mean the provider would report anything additional to the 90792. It takes as long as it takes.

Maybe they are actually rendering and documenting an E/M service? In that case, if they are also rendering and documenting psychotherapy for 30 minutes in addition to the E/M, they would report 90833. There are other considerations when it comes to this and the time of the E/M can't be mixed with the time of the 90833.
 
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mc1030 said:
Hi Everyone,

I am in Illinois billing/coding for a BH practice. I have a therapist that is using these two codes together but we had to explain that it isn’t a compatible add-on code. I explained that the only add-on that want can be use is the interactive complexity code but it’s only for increased complex, not time. The therapist misunderstood and is thinking it is for prolonged time. Is there another add on code that is compatible with 90792 that explains he went over 60 mins? I have searched online and saw something that says that is the minimum for the 90792 code is 60 mins & can exceeds up to 120 mins. I just need come clarification on this cause I keep seeing multiple of answers that are different and want to make sure I bill the therapist correctly!
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To clarify the billing for 90792 (and its compatibility with add-on codes:

1. Time and 90792:​

  • 90792 has a minimum time of 60 minutes but can indeed exceed that, often up to 120 minutes.
  • If the session exceeds 60 minutes, there’s no specific "add-on code" that can be used to account for the time, as 90792 already includes the professional services provided, regardless of the duration, within that time frame.

2. Add-on Codes:​

  • The interactive complexity code (90785) is used in specific situations where the interaction between the provider and the patient is complicated (e.g., involving third parties or significant issues related to communication). It does not account for additional time but for complexity.
  • Unfortunately, there is no direct add-on code for prolonged time associated with 90792. Prolonged time codes typically apply to office/outpatient E/M services but do not apply to psychiatric services like 90792.

3. What Can Be Done:​

  • If the therapist's session exceeds 60 minutes and requires billing for the extended time, the proper solution is not an add-on code but instead, you would need to document the time spent and ensure it falls within the proper range for 90792.
With CodeBooks, you can quickly verify code compatibility, time requirements, and add-on code usage for mental health billing. It streamlines the coding process, ensuring you bill accurately according to the latest guidelines. I would advise you to try this tool. https://codebooks.rapidclaims.ai/
 
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