On-Line digital E/M services
New codes : 6
Deleted codes: 2
Self-measured home blood pressure monitoring
New codes: 2
Remote physiologic monitoring
New code: 1
Revised code: 1
On-Line digital E/M services or e-visits:
E-visits are described as non-face-to-face “patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.”
Requirements to meet online E/M services:
Ø Patient must be established, while the problem being addressed may be new.
Ø Patient must initiate the service through Health Insurance Portability and Accountability Act (HIPAA)-compliant secure platforms, such as electronic health record portals, secure email or other digital applications.
Ø Codes can be reported once per seven-day period.
Ø Time begins with the initial personal review of the patient-generated inquiry.
Ø Time counted is spent in evaluation, professional decision-making, assessment and subsequent management.
Ø Permanent documentation storage (electronic or hard copy) of the encounter(s) is required.
CPT added six new codes to report online digital evaluation services, or e-visits. These codes describe patient-initiated digital communications provided byphysician or other qualified health care professional (99421, 99422, 99423), or anon-physician health care professional (98970, 98971, 98972).
Deleted CPT
New CPT
Time
Category
99444
99421
5-10 minutes
Online digital evaluation and management service byphysician or other qualified health care professional.
99422
11-20 minutes
99423
21 or more minutes
98969
98970
5-10 minutes
Online digital evaluation and management service bynon-physician or other qualified health care professional.
98971
11-20 minutes
98972
21 or more minutes
Online digital evaluation and management service by physician or other qualified health care professional.
New codes: 99421, 99422, 99423
99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
99422: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11– 20 minutes
99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
Online digital evaluation and management service by non-physician qualified healthcare professional.
New codes: 98970, 98971, 98972
These codes are used when the qualified non-physician professionals (eg: speech-language pathologists, physical therapists, occupational therapists, social workers, dietitians) render the online services to the patients.
98970: Online digital E/M service for an established patient for up to 7 days, cumulative time during the 7 days; 5-10 minutes
98971: Online digital E/M service for an established patient for up to 7 days, cumulative time during the 7 days; 11-20 minutes
98972: Online digital E/M service for an established patient for up to 7 days, cumulative time during the 7 days; 21 minutes or more
HCPCS codes:
When the e-visits are performed by non-physician healthcare practitioners, 98xxx codes are coded. However there are non-physician healthcare practitioners who are unable to bill Medicare but that will likely perform these e-Visits. Therefore CMS created HCPCS codes G2061, G2062, and G2063 with descriptors that refer to “assessment” rather than E/M for non-physician practitioners who are unable to bill E/M services.
Points to remember:
“Per CMS, audiologists and speech language pathologists are ineligible to bill for HCPCS codes G2061-G2063.”
G2061: Qualified nonphysician health care professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes).
G2062: Qualified nonphysician health care professional online assessment and management service for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes).
G2063: Qualified nonphysician qualified health care professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.
Billing E/M services and Online services:
When both the online service and other service are provided to the patient the following rules applies to the appropriate situation.
Reporting face-to-face E/M service:
If any face-to-face E/M visit is provided within seven days of the initiation of the online digital E/M service, the time or medical decision making of the online service should be added to that of the related face-to-face service and only the face-to-face service should be reported.
Reporting Online digital E/M services:
Online digital E/M services may be reported separately within seven days of a face-to-face E/M visit if the patient requests the online services for a different problem than those addressed at the face-to-face visit.
Do not report online digital E/M services:
Do not separately report online inquiries related to a surgery during the postoperative period.
Self-measured home blood pressure monitoring
New codes: 2
Two new codes (99473-99474) have been added for reporting self-measured home blood pressure monitoring using a validated device.
99473 – Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration.
99474 – Separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient.
Points to remember:
Ø Do not report 99473 or 99474 in the same calendar month as ambulatory blood pressure monitoring codes (93784-93790).
Ø Do not report 99473 or 99474 with interpretation of physiologic data (99091), remote monitoring of physiologic parameters (99453, 99454, or 99457), or chronic care management (99487, 99489, 99490, or 99491).
Ø If the services described by 99474 are provided on the same day the patient presents for an E/M service to the same provider, these services should be considered part of the E/M service and not reported separately.
Remote physiologic monitoring
New code: 1
Revised code: 1
Revised code: 99457
Ø CPT 99457 was revised to indicate it is reported for the “first 20 minutes of remote physiologic monitoring” per calendar month.
New code: 99458
Ø CPT 99458 was added newly to report each additional 20 minutes for remote physiological monitoring within the same calendar month