CPT Code 90792: Coding Criteria, Time Length, & Add-on Codes

Are you struggling with the CPT code 90792 while coding your medical services? We’ve got you covered with this informative blog about the code itself. We have explained the coding criteria for its diagnostic interviews and the time length allowed to conduct them.

There are also add-on codes mentioned that you can assign along with 90792. You will find some key guidelines as well that can be followed to accurately assign relevant medical procedures.

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What Is CPT Code 90792?

The CPT code 90792 is maintained by the American Medical Association. It is a medical procedural code that comes under the Psychiatric Diagnostic Evaluation Services range. You can assign this code to a psychiatric evaluation of your patient.

The evaluation is called Psychiatric Diagnosis Interview Examination. It has to be performed by a licensed mental health provider. Such evaluations are conducted in order to make a diagnosis for those patients. You can also provide some additional medical services. The CPT code 90792 is used by psychiatrists, psychiatric nurse practitioners, and physician assistants.

The full form of CPT in medical coding is Current Procedural Terminology. This name is associated with specific numeric codes that are assigned to medical services. Healthcare providers and insurance companies use CPT codes to identify those services while billing them.

What Are the Coding Criteria for Diagnostic Interviews?

The coding criteria for a diagnostic evaluation are based on fulfilling procedural requirements. These requirements are specific for the CPT code 90792. They follow mental health concerns or illnesses treated by psychiatrists.

You have to take a medical history and conduct an examination. These aspects are used to make an initial diagnosis and derive a treatment plan. This is how you determine the responsiveness of your patients to their treatment.

By doing all this, you can meet the requirements to bill 90792 as a licensed medical clinician. Some providers do not conduct a medical evaluation of their patients. In this case, they have to assign the 90791 code to their claims.

What Is the Time Length for CPT Code 90792 Evaluations?

You cannot code your diagnostic evaluations by duration of time. The requirements of intake sessions do not depend on the duration of visits. They are based on the medical services that you provide to your patients.

The minimum and maximum time that you can take is 60 and 120 minutes respectively. Providers require this time length to conduct a comprehensive diagnostic interview. They can also examine their mental health patients within these sessions.

What Are the Add-on Codes?

Add-on codes are additional codes that you can use alongside your primary ones like 90792. They represent supplemental procedures conducted in conjunction with the main service. They are not standalone codes and you must report them with a primary procedure.

This way, you can document the complete scope of your care. Add-on codes usually indicate extra work, time, or complexity in patient care. Here is a list of the add-on codes associated with the CPT code 90792:

• CPT code 90785: Used when psychiatric services involve factors that complicate communication. It is common for patients who have complex behavioral or communication issues.
• CPT code 90833: Used when a provider performs 30 minutes of psychotherapy. Such sessions are conducted in addition to a medication response evaluation.
• CPT code 90836: Used when a provider performs 45 minutes of psychotherapy. The providers conduct these sessions after they have evaluated medication responses.
• CPT code 90863: Applied when a provider manages medications as part of a treatment plan. These medications are provided immediately after psychotherapy.
• CPT code 99050: Applied when services are provided during specific times. This code comes in handy when the office is closed or you have to work outside of normal business hours.
• CPT code 99051: Applied when services are provided during regularly scheduled evenings. Those services can also be provided during the weekend or holiday office hours.

Key Guidelines for Assigning CPT Code 90792

There are some key guidelines that you must follow while assigning the CPT code 90792. Let’s take a look at them in detail:

• Once Per Day

The CPT code 90792 should only be reported once per day. Even if the provider performs multiple assessments or interventions with the same patient. The number of sessions or evaluations conducted does not matter. You are only allowed to bill for this code a single time within a 24-hour period.

This guideline ensures that multiple assessments on the same day are not double-billed. This is how you maintain accuracy and prevent unnecessary or inflated charges. It enables you to consolidate your services into one comprehensive evaluation per day.

• No Concurrent Evaluation and Management

This code should not be billed on the same day as an Evaluation and Management (E/M) service. Those services are provided by the same physician or provider to the same patient. E/M services involve tasks like patient history and physical examination. They can also include decision-making for care management.

This prevents duplication of charges for overlapping services. The CPT code 90792 already includes an in-depth assessment of mental health. It overlaps with several E/M services provided by healthcare professionals. The focus of 90792 is the psychiatric diagnostic evaluation of patients.

• Evaluation of Treatment Readiness

The provider must assess the patient’s ability and capacity to respond to treatment. These assessments have to be made during the psychiatric diagnostic evaluation. This includes evaluating the patient’s cognitive, emotional, and physical readiness.

You can evaluate their readiness for the planned treatment, therapy, or interventions. This guideline ensures that the evaluation under 90792 is comprehensive. It heavily considers whether patients are capable of engaging with their proposed care plans.

It also ensures that providers are not just diagnosing. You should also be assessing whether the treatment will be effective. Its effectiveness must be based on the patient’s current state. This way, you can make your evaluation more tailored and patient-specific.

Billing Considerations for CPT Code 90792

You must also be aware of certain considerations while billing claims associated with the CPT code 90792. Here is a detailed explanation of the primary ones:

• Initial Evaluation

The CPT code 90792 is primarily used during the initial psychiatric evaluations of patients. This is generally the first visit when a provider conducts a comprehensive assessment. You can gather all relevant information about the patient’s mental health.

The details about their medical history and current symptoms can also be documented. After this initial visit, follow-up appointments would typically require different codes. An example of such codes is 90862 which is assigned to individual psychotherapy or medication management.

Using 90792 accurately distinguishes between a first-time psychiatric assessment and subsequent ongoing treatment. The 90792 code is most appropriate while establishing a new psychiatric diagnosis. This means that the provider is formulating a fresh diagnosis during a visit.

Their diagnosis is based on the evaluation of symptoms, history, and mental status examination. The code reflects the complexity and depth of this initial diagnostic process. This billing consideration ensures that the code is used for its intended purpose.

Its purpose is based on comprehensive psychiatric assessments at the start of care. It also includes those assessments when there is no existing psychiatric diagnosis. Using this code for established diagnoses would be incorrect and could lead to billing errors.

• Comprehensive Assessment

You must conduct a comprehensive evaluation to appropriately use 90792. This means that you should conduct a detailed history. Providers also have to conduct a mental status examination and make initial diagnoses.

The evaluation should cover all relevant aspects of mental and physical health. There are psychosocial factors covered as well in such evaluations. A brief assessment will not meet the requirements for billing under 90792. The code is intended for in-depth evaluations.

They involve significant time and effort to gather information and make diagnostic decisions. Providers must ensure that the evaluation is thorough. This way, they can justify the use of this code and avoid underbilling and overbilling.

• Use of Appropriate Modifiers

Modifiers can be used in specific medical circumstances. They provide additional context to the psychiatric evaluation. They can also indicate that the evaluation was conducted under special conditions. Some examples of the modifiers for the CPT code 90792 are:

• GT Modifier: Used when the psychiatric consultation is conducted via telehealth. It indicates that the service was provided through a virtual platform.
• FQ Modifier: Used when family history is a critical part of the evaluation. It reflects that the assessment included important hereditary factors.

You may not always require modifiers for every case. However, they help clarify the context in which an evaluation is performed. This is particularly helpful for insurance purposes. A proper use of modifiers clearly indicates specific methods used during the evaluation.

Documentation Requirements for CPT Code 90792

Healthcare providers must also fulfill certain requirements in terms of their documentation. We have listed some of those requirements below:

• Medical and Psychiatric History

The provider must collect and document a comprehensive history. It should cover the patient’s medical, psychiatric, and family background. This history must provide an overview of medical conditions, treatments, and symptoms.

This includes chronic medical conditions, past surgeries, and hospitalizations. Another factor covered are relevant physical health issues. This way, you can capture prior psychiatric diagnoses, treatments, and hospitalizations.

The evaluation should also explore hereditary psychiatric conditions. There can be significant mental health issues in a patient’s family. Family history may contribute to genetic predispositions or environmental factors.

These factors and predispositions can influence the psychiatric state of a patient. The current symptoms that prompted the evaluation must be clearly documented. They should include their onset, frequency, severity, and progression.

• Mental Status Examination

The MSE is a core component of the psychiatric diagnostic evaluation. You must carefully document it for each patient. It assesses the current cognitive, emotional, and behavioral status at the time of evaluation.

This includes the patient’s orientation to various factors. Those factors include time, place, person, memory, attention, and concentration. The provider should evaluate their patient’s ability to think, reason, and process information.

Document the patient’s emotional state and whether their observed emotional expression aligns with it. For instance, a patient may report feeling sad but their expression could be flat or tearful. You must evaluate and record how your patient is thinking.

This should include logical flow of ideas, coherence, and organization of thought. Any abnormal thoughts should be clearly noted. The patient’s physical appearance, behavior, and psychomotor activity are also assessed.

• Diagnostic Impressions

The documentation must include an initial diagnostic impression. It should be based on your comprehensive assessment. This diagnosis should follow the criteria set forth in the DSM-5 or ICD-10 guidelines. They ensure that you have clearly outlined the mental health condition identified.

It is important to justify the diagnosis. You can do that by correlating it with the findings from history, current symptoms, and mental status examination. For example, a patient can be diagnosed with Major Depressive Disorder.

Their documentation should explain how the symptoms and MSE findings support this diagnosis. There can be some cases where a differential diagnosis is needed. In such cases, you should document the process of ruling out other psychiatric or medical conditions.

The Bottom Line

This blog discussed various aspects of the CPT code 90792 in detail. We covered the coding criteria for its diagnostic interviews along with the allowed time limit. We also explored some add-on codes that can be associated with this code.

The blog also detailed a wide range of guidelines that you can follow to assign 90792 accurately. Contact Health Quest Billing and get your medical services coded by our experienced coders.