Ob-Gyn Coding Alert

Find out if your payer is among those reimbursing 0074T

If your ob-gyn interacts with patients by e-mail, you may be entitled to use Category III code 0074T -- but before you do, find out what you need to meet payer guidelines.

Code 0074T Describes High-Tech E/M

You can report and 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).
 
-We recently read an article in our local newspaper regarding doctors who are using e-mail to answer patients- medical questions and getting paid for it,- says Amy Robinson, coder for Roger Rholdon, MD, in Hammond, La.
 
CPT released 0074T in July 2004 as a category III code. These temporary codes identify emerging technologies, procedures and clinical trials. Using this code allows the AMA and insurers to gather data about these services or procedures.

Some Insurers Cover Online Communication

Good news: Some insurers have already agreed to pay as much as $25 for each 0074T claim. For instance, Blue Shield of California and BCBS of Tennessee reimburse for the online E/M services. These insurers maintain their own coverage guidelines. BCBS of Tennessee, for example, requires the following criteria for 0074T payment:
 
1. Physician responds to the patient's request within 24 hours (except over the weekend, in which case he responds by end-of-day Monday).
 
2. And one or more of the following:
 
- Patient describes new symptoms and requests intervention and/or advice from physician to treat new symptoms.
 
- Patient describes ongoing symptoms from a recent acute problem or chronic health problem and requests intervention and/or advice from physician to treat said problem.
 
- Evidence that physician gives substantive medical advice, revises treatment plan, prescribes/revises medication, recommends additional testing, and/or provides self-care/patient education information for a new and/or chronic health problem.
 
- Evidence that physician makes a new diagnosis and prescribes new treatment.
 
- Patient requests interpretation of lab and/or test results with evidence that physician provides substantive explanation and possibly makes recommendations to modify treatment plan, revises medications, etc.
 
- Evidence that physician provides extended personal patient counseling that changes the course of treatment and impacts the potential health outcome.

Aetna and AFLAC do not now reimburse 0074T claims, says Carmel Schmidt, a healthcare consultant for Dermody, Burke & Brown Medical Management Services LLC in Syracuse, N.Y.
 
Best practice: Check with your major payers for their specific guidelines on 0074T reimbursement.

NCCI Bundles Internet Encounter Into Visit

You should also ask your insurer whether it has adopted the National Correct Coding Initiative's policy on the high-tech code. NCCI makes 0074T a component to every other E/M code (except 99499, Unlisted E/M service).
  
Translation: You cannot separately report 0074T and an E/M code on the same date without a modifier, such as 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). -This makes sense,- says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. -Typically, your physician won't see the patient and also bill for an online evaluation on the same day.-

Examples Show Included, Billable Online Service

If an online encounter precipitates or results from a same-day, face-to-face encounter, consider the online service part of the other service's pre- or post-service work. In this case, you should not separately report the high-tech service, according to the CPT guidelines preceding 0074T.
 
Example 1: Your ob-gyn uses the Internet to maintain contact with a pregnant patient who lives in a rural area far from his office. After the patient complains of abdominal cramping, the ob-gyn advises the patient come in to the office for a visit, and the patient makes a same-day appointment.
 
Solution: The ob-gyn should roll the online encounter into the in-person visit and bill one E/M code, such as 99213 (Office or other outpatient visit for an established patient ... 15 minutes face-to-face). The physician can use the e-mail communication work as a part of the history of present illness or medical decision-making.
 
Keep in mind: Because this is a pregnant patient, the payer may consider the visit included in the global. But your ob-gyn should, in any case, document the service and include a diagnosis code from the ob complications chapter of ICD-9 (Chapter 11).
 
Example 2: A 46-year-old female e-mails her ob-gyn requesting information on breast cancer after learning that  several female family members have developed the disease. She asks if she should see the ob-gyn for a mammogram. The ob-gyn responds to the e-mail and explains the implications of breast cancer history and gives his opinion as to whether the screening is necessary.
 
The ob-gyn also refers the patient to several online sites and attaches informational documents he regularly gives patients. For the ob-gyn's response to the online inquiry, you would report 0074T.

Online Services Require Storage, Summary

When using 0074T, remember these two correct coding requirements:
 
1. 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.-
 
2. Include all communication, such as telephone calls, prescriptions and laboratory orders, pertaining to the encounter in your documentation.

Consider Other Online Consult Methods

Ob-gyns whose state insurers do not reimburse 0074T may consider using an online consult program such as Medem.com. -A patient who wants an online consult can make the arrangements through the Web site, pay for it with a credit card, and set up a time when the appointment will take place,- says Richard H. Tuck, MD, FAAP, a physician at PrimeCare of Southeastern Ohio.
 
-Initiatives are under way to comprehensively revise non-face-to-face coding and reimbursement, including Internet and phone services,- Tuck says. Ob-Gyn Coding Alert will provide updates as these changes take effect.