Primary Care Coding Alert

Your FP can address simple medical issues on the Internet - and get paid

Your patients may love the timesavings and hassle-free benefits online E/M services can provide, and your FP may love 0074T's potential reimbursement, if you know when to use the high-tech code.

1. 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 at Roger Rholdon, MD, in Hammond, La.

And 0074T is the coding vehicle. CPT released 0074T in July 2004 as a category III code. These temporary codes identify emerging technologies, procedures and clinical trials. Use of the code allows the AMA, CMS and other agencies to gather data about these services or procedures.

2. Some Insurers Cover Online Communication

Medicare will generally not pay for 0074T, but the good new is some private carriers do.

For instance, Blue Shield of California and BCBS of Tennessee (which will pay $25) reimburse the code. Aetna and AFLAC will not, 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. For a sample of what you can expect, download BCBS of Tennessee's requirements from www.bcbst.com/providers/VBR_Pilot/ProviderVBRCommunicationdoc.pdf (see pages 6 and 7).

3. NCCI Bundles Internet Encounter Into Visit

You should also ask if the insurer adopted CMS' latest policy on the high-tech code. The National Correct Coding Initiative, version 11.0, made 0074T a component to every other E/M code (except 99499, Unlisted E/M service).

Translation: 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). "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."

4. 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: A patient e-mails your FP to ask about abdominal cramping (such as 789.00, Abdominal pain, unspecified site) and wants to know if she should come in. The physician says yes, and the patient makes a same-day appointment at your practice.

Solution: The FP would roll the online encounter into the in-person visit and bill one E/M, such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...). The physician can use the e-mail communication work as either a part of the history of present illness or a part of medical decision-making.

Example 2: Suppose for the patient with abdominal cramping the FP instead recommends OTC treatment with in-person follow-up if the patient's problems don't resolve. For the FP's response to the patient's online inquiry, you would report 0074T.

5. 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 including telephone calls, prescriptions, and laboratory orders pertaining to the encounter in the code.