Online E/M services (E-Visit)

The American Medical Association (AMA) has added new codes to report non face to face digital visits effective from Jan 1, 2020. Do not confuse with telephonic E/M codes 99441-99443 effective march 1, 2020 due to COVID-19 pandemic. Here we will talk about below codes applicable to report E-visit.

E-visit/Digital E/M definition: Non-face-to-face patient-initiated communications through an online patient portal.

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

There are also another set of code intended to use for qualified non-physician healthcare professional such as physical therapists, occupational therapists, clinical psychologists etc.

98970: Qualified non-physician healthcare professional online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes

98971: Qualified non-physician healthcare professional online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the 7 days s; 11–20 minutes

98972: Qualified non-physician healthcare professional online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

Although above 98970-98972 codes are added to 2020 CPT manual but they are not yet priced by Medicare, so you cannot bill these non-physician codes to Medicare. You need to check with private payers if anyone is reimbursing these codes in your area.

Considering that there are non-physician providers also providing these e-visits and Medicare not allowing them to bill digital E/M services CMS developed three HCPCS G codes as below to facilitate billing of these services to Medicare, but still audiologists are not eligible to bill these codes.

G2061: Qualified non-physician healthcare 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 non-physician healthcare 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 non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

As you can see descriptions of these G-codes above which is saying that these can be billable up to 7 days, cumulative time during the 7 days. You must be wondering what does this actually means. So to understand this see below guidelines to bill correctly.

• If the patient avails face to face E/M service and then initiates an E-visit for the same problem within 7 days – E-visit is not reportable.

• If the patient received digital E/M service and then presents for a separately reported face to face E/M within 7 days, only face to face E/M is billable.

Conclusion: A face to face E/M visit always supersedes if provided before or after 7 days of online digital evaluation or assessment.

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