CMS added six new codes to the 2020 CPT code set to record online digital evaluation services, sometimes known as e-visits. 99421, 99422, and 99423 indicate patient-initiated digital communications supplied by physicians or other certified health providers. 98970, 98971, and 98972 are three different numbers that indicate comparable exchanges with a non-physician health practitioner. The new codes are being driven by the increased adoption of digital health solutions such as patient portals. These solutions allow patients and clinicians to communicate asynchronously and outside of face-to-face situations, making it easier for patients who encounter transportation and schedule challenges to get answers and care.
These six new codes will assist physicians and others in reporting various digital health services, such as electronic visits via secure patient portal communications. Because digital assessment and management services are not considered telehealth services, POS 02 and modifier 95 should not be used. For communication-based specialized services, CMS requires verbal agreement (CBTS). This verbal consent is required every year and applies to all CBTS, rather than a consent/service or support for each service supply.
CPT Codes for Qualified Health Professionals Providing Digital E/M Services (QHP)
CPT Code 99421: Online digital evaluation and management (E/M) service for a pre-existing patient for up to 7 days the total time within the seven days; 5 to 10 minutes
CPT Code 99422: 11-20 minutes
CPT Code 99423: 21 minutes or more
The codes mentioned above are intended for usage while performing E/M services in a face-to-face setting on a HIPAA-compliant stable platform. These are for patient-initiated interactions and can be billed by physicians who can charge an E/M service separately. They may not be utilized for clinical staff work or for clinicians who do not provide E/M services as part of their scope of practice.
Defining 7-day period:
The seven-day timeframe starts with the physician’s or another qualified health care professional’s (QHP) initial, personal evaluation of the patient-generated query. The cumulative service time of a doctor or other QHP includes the review of the initial inquiry, an overview of health records or data pertinent to the evaluation of the patient’s condition, personal doctor or other QHP interaction with clinical staff centered on the patient’s condition, advancement of planning processes, including a physician or other QHP creation of prescriptions or ordering of tests, and subsequent communication with the patient via online, telephone, email, or other means.
- Codes are only relevant to established patients.
- CMS, as previously stated, requires verbal agreement. This verbal consent is required every year and applies to all CBTS, rather than a consent/service or approval for each service supply.
- The patient requests the service by submitting an inquiry through the portal.
- If the patient had an E/M service during the previous seven days, these codes might not be utilized for that condition. These codes may be billed if the inquiry is about a new problem (different from the problem treated at the E/M service in the previous seven days).
- Suppose a face-to-face E/M service happens within seven days of the commencement of the online service. In that case, the duration of the online service or decision-making difficulty may be utilized to pick the E/M service, but this provider may not be paid.
- During the worldwide time, surgeons may not bill for this.
- A HIPAA-compliant system, such as an electronic health record portal, secure email, or other digital applications, must be used to deliver the digital service.
For Qualified Non-Physician Health Care Professionals
The applicable codes are 98970, 98971, and 98972 for online digital E/M services offered by a qualified non-physician health care professional who may not review the doctor or other competent health care expert E/M services (e.g., speech-language pathologists, physical therapists, occupational therapists, social workers, dietitians). CMS, however, said in the 2020 Final Rule that they would not recognize these codes since CPT describes them as “evaluation and management services,” which CMS reserves only for doctors, advanced practice nurse practitioners, and medical assistants. These codes are incorrect in the Medicare payment schedule and do not have RVUs allocated to them.
CPT Code 98970: Qualified non-physician health care professional online digital evaluation and management service for an existing patient, for up to 7 days, with a total time of 5-10 minutes across the seven days.
98971 CPT Code: 11-20 minutes
98972 CPT Code: 21 minutes or more
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