When completing an initial psychiatric evaluation, psychiatrists and psychiatric mental health nurse practitioners (PMHNPs) have two main coding options: Psychiatric Diagnostic Evaluation (90791 or 90792) or an Evaluation and Management (E/M) code (such as 99205). Both options are valid, but they differ in documentation requirements, complexity, and reimbursement.
This article explains the differences and what providers should consider when coding an initial psychiatric visit.
What is a Psychiatric Diagnostic Evaluation?
CPT codes 90791 and 90792 both describe a psychiatric diagnostic evaluation. The distinction is:
- 90791: Used by non-prescribing mental health clinicians (e.g., psychologists, therapists)
- 90792: Used by prescribing medical professionals (psychiatrists, PMHNPs) and includes medical services
Key Characteristics
- Specifically designed for mental health intake visits
- No minimum time required for billing
- Can include an interactive complexity add-on for sessions with additional challenges (e.g., interpreters or multiple participants)
- Applicable in any setting—outpatient, inpatient, or telehealth
This option is often chosen for straightforward initial assessments focused on establishing a psychiatric diagnosis and treatment plan.
What is an E/M Code?
Evaluation and Management (E/M) codes are broader medical visit codes that can also be used for psychiatric intakes by prescribing providers. E/M coding is selected based on:
- The complexity of medical decision-making (MDM)
- Or the total time spent during the visit
Key Characteristics
- Often reimbursed at a higher rate than 90792
- Requires detailed documentation of medical decision-making or time
- Supports psychotherapy add-on codes (e.g., 90833), allowing combined billing for evaluation and therapy
- Commonly used for longer visits or when managing both medical and psychiatric comorbidities in the same encounter
Comparing Psychiatric Diagnostic Evaluation vs. E/M Coding
| Feature | Psychiatric Diagnostic Evaluation (90791/90792) | E/M Codes (e.g., 99205) |
|---|---|---|
| Purpose | Psychiatric-specific intake evaluation | Comprehensive medical evaluation with psychiatric care |
| Ease of Documentation | Simpler, psychiatry-focused | Requires medical decision-making or time documentation |
| Minimum Time Requirement | None | Based on visit length or complexity |
| Psychotherapy Add-On | Not applicable | Supported |
| Medical Decision-Making | Limited | Full MDM levels |
| Applicable Settings | All settings, same code | Different codes in other settings |
| Typical Reimbursement | Lower to moderate | Often higher |
Key Considerations for Psychiatrists and PMHNPs
- Scope of Visit: If the session is primarily psychiatric assessment and treatment planning, a psychiatric diagnostic evaluation code may align well.
- Medical Complexity: When the visit involves multiple medical comorbidities or significant decision-making, E/M coding may be appropriate.
- Psychotherapy During Intake: If therapy is provided during the initial evaluation, E/M codes allow psychotherapy add-ons that psychiatric diagnostic codes do not.
- Payer Policies: Reimbursement and rules can vary across insurers, influencing code selection.
Conclusion
Both psychiatric diagnostic evaluation codes (90791/90792) and E/M codes are valid for initial psychiatric visits. The decision often depends on documentation requirements, complexity of care, and payer guidelines. Psychiatrists and PMHNPs should be familiar with the distinctions to ensure accurate, compliant coding while capturing the full scope of services provided.
With PMHScribe, providers can automate documentation for both psychiatric diagnostic evaluations and E/M visits, simplifying coding and improving accuracy.
