General Surgery Coding Alert

Question: How should we report online E/M service in 2020 if it’s true that CPT^® is deleting 99444?

Codify Subscriber

Answer: It is true that CPT^® 2020 deletes 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).  

In its place, CPT^® 2020 provides new code 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).

Like its predecessor, 99421 has some significant restrictions, which stipulate that the service has to be:

• Provided to an established patient (or guardian);
• Provided by a physician or other qualified health care professional (QHP); and
• Unrelated to an E/M service provided within the previous seven days.

That means you cannot separately report any online digital E/M service that results from a previous E/M visit, or that results in a subsequent, E/M visit. Instead, you should incorporate the online E/M service into the related E/M visit code.

CPT^® also places a seven-day cumulative time limitation on 99421 and makes the code time-dependent. You will be able to use 99421 if your provider spends between five and 10 minutes on any asynchronous communications with the patient in that time; you will also be able to report longer time increments with new codes 99422 (… 11-20 minutes) or 99423 (… 21 or more minutes).

Time: “Coders will need to work with their providers to ensure that they are documenting the time factors of the new codes,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “The time component was not required for 99444, so this will be an opportunity for education.”