Urology Coding Alert

New codes get more specific for digital service times.

The closer the calendar rolls to 2020, the more you need to dig into any coding changes that might affect your reporting in the new year. We introduced a few updates of interest to urology practices in Urology Coding Alert Vol. 21, N. 11 (see “Watch for These New Code Options in 2020”). Now, here’s additional information on how you’ll put some of those changes into practice, for both physicians and qualified non-physician healthcare professionals (QNHP) for certain online patient management services.

Count Every Minute of the Encounter

CPT^® 2020 deletes code 98969 (Online assessment and management service provided by a qualified nonphysician health care professional …). It will be replaced by three new time-based codes to report the same, asynchronous online services to patients by QNHP (PAs, NPs, etc.):

• 98970 (Qualified nonphysician health care profes­sional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5­10 minutes)
• 98971 (… 11­20 minutes)
• 98972 (… 21 or more minutes)

Parallel: Coding experts welcome these changes, because they bring the codes into line with several similar services.

“These new codes mimic the [existing QNHP] “telephone call” codes 98966-98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment …), which have the same stipulated times,” notes Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Physician Option Will Mirror the Change

The deletion of 98969 and introduction of the three time-based replacement codes mirrors what will also happen to the corresponding “physician 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), notes Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

However, remember that 99444 will be deleted from CPT^® 2020 and replaced with:

• 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5­10 minutes)
• 99422 (… 11­20 minutes)
• 99423 (… 21 or more minutes)

Track time: “Coders will need to work with their providers to figure out how the provider is going to track the time over the seven days and report the appropriate code when the seven days are up,” Moore says.

Alert: Both experts add a note of caution, especially in terms of the criteria you must meet to use the codes. “As noted in the descriptor, these codes are for QNHPs,” Moore says. Additionally, “they can only be used for established patients,” Holle explains.

And even if you follow the guidelines to the letter, “like the telephone call codes, these new digital codes may not be payable,” Holle says. Coders should check with the payers to whom they submit claims most often to learn how those payers intend to handle and pay these new codes.