Unfortunately, only half of individuals with mental illness receive treatment. These numbers highlight a significant gap in care. However, with integrated psychiatric services, such as CPT code 90792, psychiatrists are at the forefront of closing this gap.
This vital procedural code not only focuses on mental health evaluations but also emphasizes medical services.
Our billing experts at MediBillMD have designed this comprehensive guide to simplify the complex billing process associated with these services.
Thus, if you are a mental health practice struggling with a slower revenue cycle, this guide is for you!
CPT Code 90792 – Description
CPT code 90792 covers a psychiatric evaluation to diagnose the patient’s condition. Moreover, it involves psychiatric medication management services.
Did you know that in 2022, there were 59.3 million U.S. adults with mental illness? For context, mental illness can be categorized into two types: any mental illness (AMI) and serious mental illness (SMI).
Scenarios Where CPT Code 90792 is Applicable
Discussed below are a few real-world clinical scenarios where psychiatric assessment with medical services applies:
Depression and Insomnia
Picture a 33-year-old male patient who comes to the clinic for a psychiatric diagnostic evaluation. He has been experiencing worsening symptoms of depression and severe insomnia.
Thus, the physician performs a detailed assessment to determine the severity of depression. Moreover, due to insomnia, the provider orders a lab test to check for any vitamin deficiencies and prescribes a sleep medication.
Here, CPT code 90792 applies.
Anxiety with Physical Symptoms
Assume a 36-year-old female patient who visits the psychiatrist. She complains of severe anxiety, including shortness of breath, frequent panic attacks, and heart palpitations.
Thus, the physician performs a complete psychiatric diagnostic evaluation to assess panic and anxiety-related symptoms. The provider also conducts a brief medical examination and orders blood work to rule out thyroid issues. Moreover, he prescribes anti-anxiety medications to help the patient manage her condition.
Here, the psychiatrist will report CPT code 90792 to bill for the service.
Bipolar Disorder and Medication Management
Imagine a 47-year-old male patient with a history of bipolar disorder. He visits the clinic for a psychiatric evaluation. Therefore, the physician assesses the patient’s current mood status following a recent episode.
During the visit, the physician notes significant side effects of the medication. These include weight gain and tremors. As a result, the psychiatrist orders a therapeutic drug level test to address these medication issues. Moreover, he adjusts the current dosage to reduce the potential side effects.
Here, CPT code 90792 applies.
Applicable Modifiers for CPT Code 90792
The following are the applicable modifiers related to CPT 90792:
Modifier 95 & GT
What happens when a physician performs psychiatric evaluations and medical services via audio/video telecommunication systems? You append modifiers 95 or GT to CPT code 90792 to identify the service as a telehealth visit.
At present, most insurance payers prefer modifier 95. However, some might still require you to append the modifier GT. Therefore, you should communicate with the relevant payer to determine the acceptable modifier for reporting telehealth encounters.
Modifier AF, AH, AJ & HP
When your healthcare practice is eligible to bill for CPT code 90792 coordinated with other licensed mental health providers, you must append one of the following modifiers:
- AF – A psychiatrist (MD) performs the services covered under CPT 90792.
- AH – A doctorate-level degree or a clinical psychologist (PhD or PsyD) conducts the evaluation and medical services.
- AJ – A Licensed Clinical Social Worker (LCSW) performed the psychiatric assessment.
- HP – A PsyD or PhD renders the evaluation service.
Note that modifiers AH and HP mean the same. Use any one of these as per the payer’s specific policies.
CPT Code 90792 – Billing & Reimbursement Guidelines
Here, let’s take a look at the essential billing and reimbursement guidelines related to psychiatric assessment with medical services:
Follow the Documentation Requirements
Comprehensive and accurate documentation is essential for faster claim processing. Besides, it supports the medical necessity of the performed services covered under CPT code 90792. Thus, it must include the following:
- Detailed psychiatric and medical history of the patient.
- Complete mental status examination.
- An initial diagnosis based on the assessment using the Diagnostic and Statistical Manual of Mental Disorders (also known as DSM-5).
- Treatment plan to manage the patient’s conditions and symptoms.
- Any medication management services, including ordering lab tests, prescribing medications, or performing a physical examination.
Do Not Bill CPT Code 90792 When the Physician Does Not Perform Medication Management
Note that if the physician only renders the psychiatrist evaluation without any medication management services, CPT 90792 does not apply.
However, there is another more relevant procedural code available, i.e., CPT 90791. Thus, you should report that to ensure coding accuracy and avoid denials.
Bill CPT Code 90792 Only Once Per Patient Per Diagnosis
You can only report this code once per patient until the physician makes a new diagnosis. For instance, a patient came to the clinic and you performed a psychiatric evaluation, diagnosed depression, and offered medical services. You reported CPT 90792 for the services.
Now, let’s say after 7 months, the patient visits the mental health clinic. This time, you diagnose paranoia. So, you can bill CPT 90792 again for this patient.
Summary
With that said, we have come to the end of this guide. However, before concluding, let’s recap everything that we discussed.
First, we explained the CPT code 90792 descriptor. It covers psychiatric evaluation for diagnosing mental illness, and also involves medication management services.
Next, we shared some clinical scenarios where this procedural code applies. These include diagnosing, treating, or managing depression and insomnia, anxiety with physical symptoms, and bipolar disorder.
We also listed some of the applicable modifiers for CPT 90792, including 95, GT, AF, AH, AJ, and HP.
Finally, we discussed the key billing and reimbursement guidelines related to the psychiatric assessment with medical services.
With these details, billing for CPT 90792 will become a breeze. However, if you still struggle with denials or payment delays, feel free to outsource mental health billing services to MediBillMD.
