CPT 90791 + ICD-10 F60.3: Borderline personality disorder
Psychiatric diagnostic evaluation billed with Borderline personality disorder — documentation requirements, denial reasons, modifiers, and reimbursement context.
CPT Code
90791
Psychiatric diagnostic evaluation
ICD-10 Code
F60.3
Borderline personality disorder
Compatibility Notes
Used for the initial evaluation where BPD is the presenting diagnosis or emerges during intake. The evaluation should document the nine BPD criteria per DSM-5 and rule out bipolar disorder and PTSD as differential diagnoses. Most payers cover 90791 for BPD intake evaluation without prior authorization.
Documentation Required
- ✓Comprehensive evaluation with BPD DSM-5 criteria (at least 5 of 9) documented
- ✓Differential diagnosis: bipolar disorder and PTSD assessed and addressed
- ✓Trauma history reviewed
- ✓Safety assessment: self-harm history, suicidal ideation, crisis behaviors
- ✓DBT or other evidence-based BPD treatment plan initiated
Common Denial Reasons
- ✗BPD criteria not specifically enumerated in the evaluation note
- ✗90791 billed more than once per year by same provider
- ✗Differential for bipolar disorder not documented
Applicable Modifiers
Reimbursement Notes
OON UCR $175–$350. BPD evaluations are covered under mental health parity. Thorough documentation of DSM-5 criteria is essential to withstand audit.
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