Wiki E/m codes vs 90792

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sluke9

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I am pretty new to behavioral health coding and would like to get some feedback or other places to get information to determine when E/M levels should be used instead of billing 90792. In the AMA/CPT book under Psychiatry it talks about using E/M 'when appropriate'. Can anyone help with how you determine 'when appropiate' is applied? Our providers all bill with E/M codes for any service other than counseling. I think that initial diagnostic evaluations should be billed as 90792 regardless of the insurance but the providers don't agree.
Thanks for any help!
 
I am also new to BH coding and have this same question. Everything I find says you can use 90792 or the E/M codes. Some of my providers use E/M and some use 90792. I'm trying to find some concrete information on the documentation differences for both. My main question is does a complete ROS have to be documented for 90792? Anyone have any info or links that will give us some guidance?
Thanks!
 
I work for a behavioral health office and our doctors use the 90792 for the inital visit as that is when they are providing the psych eval, and our therapists use the 90791. The subsequential visits are billed as 99213 or 99214 where appropriate.
 
I work in Mental Health and we use 90792 for Psychiatrists, 90791 for Psychologists for the initial visit and then an E/M code 99212-99215 for any follow-up visits with the psychiatrist.
 
In our OMH licensed MH clinic we allow prescribers (MD/NP) to use 90792 for initial assessment. 90791/90792 can be used up to 3 times in a row per episode of care. This code allows our prescribers to meet with the parents of children to gather psychosocial information as E&M codes would be difficult to bill when the child isn't present.
 
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