How To Use CPT Code 90792

CPT 90792 describes the procedure for a psychiatric diagnostic evaluation with medical services. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90792?

CPT 90792 can be used to describe a psychiatric diagnostic evaluation with additional medical services. This code is used when a provider performs a comprehensive evaluation to diagnose a patient’s psychiatric condition. The evaluation includes collecting information about the patient’s behavior concerns, medical history, and social history. The provider may also perform physical examinations, order and interpret lab tests, and assess the patient’s condition. The goal is to make a definitive diagnosis and develop a comprehensive treatment plan.

2. Official Description

The official description of CPT code 90792 is: ‘Psychiatric diagnostic evaluation with medical services.’

3. Procedure

1. The provider performs a comprehensive diagnostic evaluation, collecting information about the patient’s behavior concerns, medical history, and social history.
2. The provider may perform physical examinations, order and interpret lab tests, and assess the patient’s condition.
3. The provider may interview family members and friends of the patient to gather additional information for a definitive diagnosis.
4. The provider may prescribe medication and develop a psycho-social comprehensive treatment plan.
5. The provider may refer the patient for psychological, neuropsychological, developmental, or speech, language, and occupation therapy evaluations as needed.

4. Qualifying circumstances

CPT 90792 is used for new patients or patients undergoing re-evaluation who require a comprehensive psychiatric diagnostic evaluation. The evaluation includes collecting information about the patient’s behavior concerns, medical history, and social history. The provider may also perform physical examinations, order and interpret lab tests, and assess the patient’s condition. The goal is to make a definitive diagnosis and develop a comprehensive treatment plan.

5. When to use CPT code 90792

CPT code 90792 should be used when a provider performs a comprehensive psychiatric diagnostic evaluation with additional medical services. This code is appropriate for new patients or patients undergoing re-evaluation who require a comprehensive evaluation to diagnose their psychiatric condition. It should not be reported in conjunction with certain other codes, such as those for evaluation and management services or certain therapy evaluations.

6. Documentation requirements

To support a claim for CPT 90792, the provider must document the following information:

• Patient’s behavior concerns, medical history, and social history
• Physical examinations performed and their findings
• Lab tests ordered and their results
• Assessment of the patient’s condition
• Interviews with family members and friends, if conducted
• Diagnosis and comprehensive treatment plan
• Referrals for additional evaluations, if made

7. Billing guidelines

When billing for CPT 90792, ensure that the provider performs a comprehensive psychiatric diagnostic evaluation with additional medical services. This code should not be reported in conjunction with certain other codes, such as those for evaluation and management services or certain therapy evaluations. It is important to use this code only once per day, regardless of the number of sessions or time spent with the patient on the same day.

8. Historical information

CPT 90792 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Examples

1. A psychiatrist performing a comprehensive diagnostic evaluation for a new patient with symptoms of depression.
2. A psychologist conducting a re-evaluation for a patient with a history of anxiety disorder.
3. A psychiatric nurse practitioner performing a comprehensive evaluation for a new patient with symptoms of bipolar disorder.
4. A social worker conducting a re-evaluation for a patient with a history of post-traumatic stress disorder.
5. A psychiatrist performing a comprehensive diagnostic evaluation for a new patient with symptoms of schizophrenia.
6. A psychologist conducting a re-evaluation for a patient with a history of obsessive-compulsive disorder.
7. A psychiatric nurse practitioner performing a comprehensive evaluation for a new patient with symptoms of attention-deficit/hyperactivity disorder.
8. A social worker conducting a re-evaluation for a patient with a history of substance use disorder.
9. A psychiatrist performing a comprehensive diagnostic evaluation for a new patient with symptoms of eating disorder.
10. A psychologist conducting a re-evaluation for a patient with a history of personality disorder.