Ob-Gyn Coding Alert

Reportable online services require permanent storage

A patient e-mails your ob-gyn to ask about intermittent vaginal bleeding and wants to know if she should come in. The ob-gyn says yes, and she is able to make a same-day appointment at your practice. If you try to report the online code 0074T in addition to an E/M code (99201-99456), you may find yourself facing a denial.

National Correct Coding Initiative edits, version 11.0, have made 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) a component to every other E/M code (except 99499, Unlisted E/M service).

Translated to you: This means you cannot separately report 0074T without a modifier such as modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
 
"Typically your physician won't see the patient and also bill for an online evaluation on the same day," says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.

"This makes sense," Hammer says. "If a physician is doing an online evaluation for an established patient, it probably means the patient isn't geographically accessible. If they can see them in person, then why should Medicare pay for an online visit?"

If the patient with the intermittent vaginal bleeding turns up in the office later the same day, you should only report the final service. "In the case presented above, the ob-gyn would add his communication work and count it toward seeing her the same day in the face-to-face visit," says Melanie Witt, RN, CPC, MA, an independent coding consulting in Fredericksburg, Va. "The ob-gyn can use it as either a part of history of present illness or a part of medical decision-making."

Keep in mind: The notes describing an online medical evaluation (0074T) state that the "reportable services involve the physician's personal timely response to the patient's inquiry and must involve permanent storage (electronic or hard copy) of the encounter." A reportable service encompasses the sum of communication pertaining to the online patient encounter or problems, according to the AMA.

Editor's note: You can find these notes at www.ama-assn.org and then search for "Category III."