AMA CPT releases new online digital E/M services codes for private payers

Effective Jan. 1, 2020, the AMA CPT deleted CPT code 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the internet or similar electronic communications network) ) and replaced it with three new CPT codes 99421 – 99423 (Online Digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days).

Online digital evaluation and management (E/M) codes 99421, 99422, 99423

These three new codes are time-based, patient-initiated services with physicians or physician assistants/nurse practitioners (PAs/NPs). To be reported to a private payer, they require the physician’s or PA’s/NP’s evaluation, assessment, and management of the patient and are intended for patient-initiated digital communications that require a clinical decision that would have been otherwise typically provided in the physician’s office. These new codes offer the opportunity to gather information through a review of the patient’s records and the ability to develop a diagnosis and possible management plan. These codes are not for electronic communication of test results, scheduling of appointments, or other communication that does not include E/M.

CPT codes 99421 – 99423 are reported for established patients, although the patient’s problem may be new to the individual providing the service. The patient will initiate these services through a HIPAA-compliant secured platform such as an EHR portal, secure email, or other digital applications which allow digital communication with the physician or PAs/NPs.

Please check with your individual payers to determine if they pay for this service.

How to report online digital E/M services The online digital E/M services are reported once for the physician’s or the PA or NP’s cumulative time devoted to the service during a seven-day period. The seven-day period begins with the physician’s or PA’s/NP’s initial, personal review of the patient-generated inquiry.

The cumulative service time includes review of the initial inquiry, review of patient records or data pertinent to assessment of the patient’s problem, personal physician or non-physician clinician interaction with clinical staff focused on the patient’s problem, development of management plans, including generation of prescriptions or ordering of tests, and subsequent communication with the patient through online, telephone, email, or other digitally supported communication, which does not otherwise represent a separately reported E/M service.

All professional decision-making, assessment, and subsequent management by anyone in the same group practice contribute to the cumulative service time of the patient’s online digital E/M service. Online digital E/M services require permanent documentation storage (electronic or hard copy) of the encounter.

Avoid online digital coding pitfalls

If an in-person E/M encounter occurs within seven days of the initiation of an online digital E/M service, the work devoted to the online digital E/M service is incorporated into the separately reported E/M visit (eg, additive of visit time for a time-based E/M visit or additive of decision-making complexity for a key component-based E/M visit). This includes E/M visits and procedures that are provided through synchronous telemedicine visits using interactive audio and video telecommunication equipment, which are reported with modifier 95 appended to the E/M service code.

Summary of CPT codes for online digital E/M service for private payers

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: 11-20 minutes

99423: 21 or more minutes

• (Report 99421, 99422, 99423 once per 7-day period)

• (Clinical staff time is not calculated as part of cumulative time for 99421, 99422, 99423)

• (Do not report online digital E/M services for cumulative service time less than 5 minutes)

• (Do not count 99421, 99422, 99423 time otherwise reported with other services)

• (Do not report 99421, 99422, 99423 on a day when the physician or other qualified health care professional reports E/M services [99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245])

• (Do not report 99421, 99422, 99423 when using 99091, 99339, 99340, 99374, 99375, 99377, 99378, 99379, 99380, 99487, 99489, 99495, 99496 for the same communication[s])

• (Do not report 99421, 99422, 99423 for home and outpatient INR monitoring when reporting 93792, 93793)

For more information on the revised guidelines, please see the AAD Coding and Billing Manual or visit the AAD Teledermatology Toolkit.

Q. A 58-year-old established female patient develops an itchy rash on both hands and arms after doing multiple loads of laundry. She sends an email to Dr. Tiden with images of the area irritated due to persistent scratching and now seeks guidance on how to alleviate the itch. She indicates that she recently changed her laundry detergent.

Dr. Tiden reviews the email and images received and sends an email inquiry back to the patient asking the patient for more information on other products the patient has been in contact with. After review of subsequent email, Dr. Tiden feels the rash is most consistent with contact irritant dermatitis due to new laundry product. Dr. Tiden recommends and orders topical medication to be picked up from the pharmacy.

The total time spent on review of images and email response is documented in the patient’s medical record, of which 4 minutes was spent on record review and 5 minutes for the email responses, a total of 9 minutes.

How would this encounter be reported?

A. CPT code 99421 is reported for this encounter.