Internal Medicine Coding Alert

Question: I recently read that we can charge insurers for our physician's online consultations, such as e-mails to patients in lieu of after-hours phone calls. How should  we bill for this?


Tennessee Subscriber

Answer: You can bill for electronic communications with your established patients using 0074T (Online evaluation and management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient). CPT released 0074T in July 2004 as a category III code.

Good news: Some insurers have already agreed to pay up to $25 for each claim with 0074T. For instance, Blue Shield of California and BCBS of Tennessee reimburse for online E/M services. These insurers maintain their own coverage guidelines. Other payers, such as Aetna and AFLAC, do not yet cover these services.

Important: According to CPT guidelines, if you report 0074T, you must permanently store the records. CPT's notes describing an online medical evaluation (0074T) state that the services "must involve permanent storage (electronic or hard copy) of the encounter."

In addition, you should include all communication including telephone calls, prescriptions, and laboratory orders pertaining to the encounter in your documentation.

Answers to You Be the Coder and Reader Questions were answered/reviewed by Jim Collins, CPC, CHCC, president of Compliant MD Inc.; Kathy Pride, CPC, CCS-P, director of consulting and training for QuadraMed in Reston, Va.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.