Pain Management Coding Alert

Question: How do we document email exchanges between a patient’s guardian and our PM specialist or nonphysician provider (NPP)? Can we also bill for these services?

Connecticut Subscriber

Answer: There are two codes you should use in these circumstances.

CPT^® code 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) describes the service as provided by a physician.

CPT^® guidelines and the code’s descriptor tell you how to document the service:

• You must document that the provider’s email is in response to an initial email sent by a patient or guardian.
• Your practice must permanently store an electronic or paper copy of the encounter.
• You must report the episode of care only once even when it requires multiple exchanges — even between multiple physicians.
• The encounter must not be related to an evaluation and management (E/M) service that your group performed and reported within the previous seven days, or within the postoperative period of a previously completed procedure.
• You must document any related telephone calls, prescription provision, and laboratory orders.

Additionally, your provider must perform the service for an established patient in a timely manner.

The guidelines also stipulate that you should report “an online medical evaluation provided by a qualified nonphysician health care provider” with 98969 (Online assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network). All the guidelines associated with 99444 apply to 98969, with the obvious exception of the provider’s qualifications.

Pay? As for receiving payment for the services, many payers will not reimburse for the codes. However, it is important that you document them regardless of the payer’s position.

This is true for phone calls as well. Although there are codes for billing phone calls, most payers do not cover them. But it is important that you document them in the same way as you document the online medical evaluation.  

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