Pulmonology Coding Alert

Question: We were preparing to report online E/M code 99444, but we learned that it’s no longer valid. How should we report online E/M services for our patients?

Connecticut Subscriber

Answer: CPT^® 2020 deleted previous online E/M 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…). In the place of 99444, you can use new online digital E/M codes 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes), 99422 (… 11-20 minutes), and 99423 (… 21 or more minutes).

CPT^® guidelines define 99241-99423 as “patient-initiated services with physicians or other qualified health care professionals (QHPs).” Follow these rules when reporting 99421-99423:

• Rule 1: Online digital E/M services require a physician or other QHP’s evaluation, assessment, and management of the patient. You should not report 99421-99423 for “the nonevaluative electronic communication of test results, scheduling of appointments, or other communication that does not include E/M,” per CPT^®.
• Rule 2: Patients should use Health Insurance Portability and Accountability Act (HIPAA)-compliant platforms to initiate online the digital E/M services. Examples of such platforms include electronic health record (EHR) portals, secure email, and other digital applications.
• Rule 3: The patient must be established to the group practice to appropriately report 99421-99423, but the patient’s problem can be new to the physician or other QHP.
• Rule 4: The physician or other QHP must permanently store the documentation from all online digital E/M encounters. This can be an electronic or hard copy.
• Rule 5: You should not calculate clinical staff time as part of cumulative time for 99421-99423.
• Rule 6: Never report online digital E/M services for cumulative service time that is less than five minutes.
• Rule 7: Do not report 99421-99423 if the inquiry results in a face-to-face E/M encounter within seven days.
• Rule 8: Do not report 99421-99423 if the inquiry takes place within seven days of a face-to-face encounter, involving the same issue.