2020 EM Codes AMN healthcare RCS

Online Digital E/M Services

New for 2020 are Evaluation and Management (E/M) codes to report online digital services. The purpose of these codes is to report physician/qualified health care professionals (QHPs) and nonphysician time spent performing E/M services in response to patient-initiated inquiries within online digital environments such as patient portals.  These inquires must be initiated through HIPAA compliant portals such as EHR portals and secure email.

The codes are:

Physician or Other Qualified Health Care Professional
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

98970 Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
98971      11-20 minutes
98972      21 or more minutes

These codes are to be used for established patients only that require evaluation, assessment, and management services.  As with most time-based codes in CPT, its best practice to document the actual time spent and duties performed in the patient’s health record.  The instructions in CPT state the “clock” begins with the initial review of the patient’s inquiry. 

TIME INCLUDES:

  • Reviewing the initial inquiry
  • Reviewing patient records or data to assess the issue
  • Interacting with clinical staff focused on the issue
  • Development of treatment plans
  • Generating prescriptions
  • Ordering tests
  • Subsequent communication with the patient through online, telephone, email, or other digital form of communication

TIME DOES NOT INCLUDE:

  • Clinical staff time
  • Nonevaluative electronic communication of test results
  • Scheduling appointments
  • Other services that do not include E/M

Another component of these codes is the 7-day window.  The time is cumulative within a 7-day period and is reported only once per 7 days.  This time also includes time spent by all providers in a group practice involved in the patient’s inquiry.   Note that these codes start at 5 minutes so anything less than that is not reportable.  

DO REPORT:

  • If the patient inquiry is for a new problem within 7 days of previous unrelated E/M service
  • If the patient has a new issue unrelated to previous online digital E/M service the time is added onto the 7-day cumulative time
  • If a separately reportable E/M service occurs within the 7-day window then the online digital time is rolled into the visit time. The digital online time can be added to time-based E/M services, or counted towards the decision-making complexity.  This includes telemedicine visits reported with modifier 95 synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.

DO NOT REPORT:

  • On a day the patient is being seen for other E/M based services
  • If patient’s inquiry is related to a previous E/M service within the 7-day window
  • If the inquiry is related to a procedure within the post-operative period

These guidelines are the same for the nonphysician online digital E/M services (98970-98972).  CPT identifies nonphysician personnel as, but not limited to, speech-language pathologists, physical therapists, occupational therapists, social workers, and dieticians.  

Staying up to date on code changes each year is important for all coders.  Our coders are provided coding education through our LMS (learning management system) to help them understand the new codes and apply them correctly.  We have the workforce solutions to assist with all of your HIM coding needs.