General Surgery Coding Alert

Revisions mirror physician E/M changes.

If your surgical practice engages qualified non-physician healthcare professionals (QNHP) for certain online patient management services, you should be ready to change how you code that work when CPT® 2020 becomes effective Jan. 1.

Take Advantage of Minutes Spent

CPT^® 2020 deletes 98969 (Online assessment and management service provided by a qualified nonphysician health care professional …), and in its place, you’ll be able to use three new time-based codes to report the same, asynchronous online services to your patients:

• 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).

Parallel: Our coding experts welcome these changes, because they bring the codes into line with several similar services.

“These new codes mimic the [existing QNHP] telephone call codes 98966-98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment …), which have the same stipulated times,” notes Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

“They also mirror what has been done to the corresponding physician code, 99444,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. Refer to the previous article in this issue of General Surgery Coding Alert to learn more about those changes.

Track time: “Coders will need to work with their providers to figure out how the provider is going to track the time over the seven days and report the appropriate code when the seven days are up,” Moore says.

Alert: Both experts add a note of caution, especially in terms of the criteria you must meet to use the codes. “As noted in the descriptor, these codes are for QNHPs,” Moore says. Additionally, “they can only be used for established patients,” Holle explains.

And even if you follow the guidelines to the letter, “like the telephone call codes, these new digital codes may not be payable,” Holle says. Coders should check with the payers to whom they submit claims most often to learn how those payers intend to handle these new codes.