EM Coding Alert

Question: When our providers perform online digital E/M services (99421-99423) services, what activities count toward cumulative service time?

New Mexico Subscriber

Answer: According to CPT^® the physician’s cumulative service time includes:

• Reviewing the patient’s initial inquiry, which is when the seven-day period begins.
• Reviewing patient records or data relevant to assessing their problem.
• Personal physician or other qualified healthcare professional (QHP) interaction with the clinical staff that focuses on the patient’s problem.
• Developing management plans, which include writing prescriptions and ordering tests.

Any 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.

Important: “All professional decision making, assessment, and subsequent management by physicians or other QHPs in the same group practice contribute to the cumulative service time of the patient’s online digital E/M service,” per CPT^®.