Wiki billing 90791 when patient is not present

[Texmexsop1]

I have some neuropsychologists that have the parents come in for the first visit, then have the patient come in for the second visit. I saw a presentation that said it's OK to bill for 90791 for BOTH visits. However, I disagree because a mental status exam can't be performed if the patient isn't present.

I know most insurance companies will prob only pay for the first one billed, and since they do this for all pediatric patients - it's not a special circumstance. Any thoughts or guidance for Texas providers?

 

[Squiabro]

90791 without patient present. Ref American Academy of Child and Adolecent Psychiatry

Hi There! Link at end of explanation.
Code 90791
-Psychiatric Diagnostic
Evaluation without medical services.
The evaluation may include communication with family or other sources, and review and
ordering of diagnostic studies.
Use +90785 in conjunction with 90791when the diagnostic evaluation includes
Interactive Complexity services.
Code 90792 Psychiatric Diagnostic Evaluation with medical services.
The evaluation may include communication with family or other sources, prescription of
medications, and review and ordering of laboratory or other diagnostic studies.
Use +90785 in conjunction with 90792 when the diagnostic evaluation includes
Interactive Complexity services

Note

?With medical services? refers to medical ?thinking? as well as medical activities, such as physical examination, prescription of medication, and review and ordering of medical diagnostic tests.Medical thinking must be documented, e.g. consideration of a differential diagnosis, medication change, change in dose of medication, drug interactions, etc.

In certain circumstances one or more other
informants (family members, guardians, or significant others) may be seen in lieu of the patient.

Codes
90791, 90792 may be reported more than once for the patient when separate
diagnostic evaluations are conducted with the patient and other informants on different days.

Use the same codes,
90791and 90792 for later reassessment, as indicated.

Do not report codes
9079and 90792on the same day as a psychotherapy or E/M

http://www.aacap.org/App_Themes/AAC...ractice/cpt/2013_CPT_module_November_2012.pdf

 

[chrissyfegan]

Diagnosis for 90791 with patient not present

I understand that 90791 can be billed for both the patient and another informant if done on different days. However, if the therapist meets with the parents first, should they assign a diagnosis/sign/symptom code after that visit, or are they able to wait until the completion of the 90791 with the patient to do so?

Also while several payors confirm the 90791 can be billed without the patient present, I don't understand how to document the mental status exam. What's been everyone's experience with this?

Thank you!

Chrissy Fegan, CPPM