Online Medical Evaluations

CPT 2008: 99444 and 98969

Recognizing that web-visits are no longer considered “emerging technology” CPT 2008 has introduced two permanent codes for reporting online medical evaluations. Category III code, 0074T, has been retired.

A blackberry in use

Some health plans are now providing reimbursement for online medical evaluations and also provide secure sites for this type of doctor-patient communication. Payment is automatically forwarded to the physician when the charges are approved. There are also web-based vendors who provide secure messaging and payment on a fee-for-service basis.

Medicare and many commercial plans have designated Online Medical Evaluations as Non-Covered, in which case you are free to bill for it. Physicians should contact their payers in order to determine possible conflicts or contract violations and should also confirm liability coverage with their malpractice carriers before providing this type of service.

CPT 99444 On-Line Medical Evaluation by a Physician

Online evaluation and management service provided by a physician to an established patient, guardian, or health care provider not originating from a related E/M service within the previous 7 days, using the Internet or similar electronic communications network.

CPT 98969 On-Line Medical Evaluation by a Non-Physician

Online assessment and management service provided by a qualified non-physician health care professional to an established patient, guardian, or health care provider not originating from a related E/M service within the previous 7 days, using the Internet or similar electronic communications network.

Guidelines

  • Reportable services involve a personal and timely response to the patient’s inquiry, and must include permanent storage (electronic or hard copy)
  • The online encounter is reported only once for the same problem/issue during a seven-day period, and includes the sum of all communication related to the online encounter (eg telephone calls, prescriptions, lab orders).
  • If the online encounter relates to and occurs within 7 days of another E/M service performed and reported by the same provider for the same problem, it is not separately reportable.
  • If the online encounter relates to a procedure performed by the same physician and occurs during the global post-operative period, it is not separately reportable.
  • Online services should not be reported for care plan oversight or anticoagulation management when the same communication is reported using codes 99339-99340, 99374-99380, or 99363-99364.
  • Online services which result in a face-to-face visit for the same problem may be reported in addition to the face-to-face visit.

Example: A patient emails her physician to request information about cancer screening after learning that there is a history of breast, colon, and prostate cancer in close family members. The physician responds and explains the implications of the family history, reviews risk factors, and offers an opinion as to what types of screening may be appropriate. The physician may also direct the patient to informational websites or attach handouts that are routinely provided to patients.

Example: The mother of a 16 year old patient with cystic acne, controlled with topical medications, emails the physician because of a recent flare-up. She is concerned about scarring and desires information about other appropriate treatment options, and the impact of diet and stress on the condition. The physician responds to her concerns, offers a short course of antibiotic therapy, provides long-term treatment options, and instructions for a follow-up visit.

A Word About Email

Many physicians are already using email to communicate with patients, and some are offering a fee-based email service.

Keep in mind that standard email is not authenticated or encrypted and can be intercepted by others. Patients often use email addresses furnished by their employers who may monitor their communications. Standard email does not meet HIPAA standards for privacy.

The AMA has developed guidelines for physician-patient email communications.