Evaluation and Management code changes 2020

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.

99474Separate 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

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