On-Line Digital Evaluation & Management Services (New 2020)

Updated 3-19-2020 On-Line Digital Evaluation & Management Services (New 2020)

Providers who have patients that cannot make appointments due to need for isolation, quarantine, or social distancing may still need your management and when done as an online evaluation or phone call there are two code sets that may fit this scenario.

Special Note: Non-secure platforms may be used such as Skype and FaceTime even though they are not HIPAA compliant,  per federal instructions of the COVID-19  crisis.

Online Digital Evaluation and Management Services

99421 (RVU 0.43) 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 (RVU 0.86)                11—20 minutes

99423 (RVU 1.39)                21 or more minutes

These are patient-initiated E/M services for the assessment and management of the patient. These are not intended for the no evaluative electronic communication of test results, scheduling of appointments, or other communication that does not include E/M.

If the patient had an E/M service within the last seven days, these codes may not be used for that problem.

If the inquiry is about a new problem (from the problem addressed at the E/M service in the past 7 days), these codes may be billed.

“Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days.”

The digital service must be provided via a HIPAA compliant platform, such as an electronic health record portal, secure email or other digital applications. But this has been waived under the current status.

Calculate minutes for 99421-99423
To count the time for these codes, start the seven-day clock when the physician or qualified health provider first performs a personal review of the patient’s question. Add in the time for the review of relevant patient records and data, interaction with clinical staff regarding the patient’s problem, developing management plans (including prescriptions and test orders), and further communication with the patient by a digital means that doesn’t fall under another E/M code. Include decision-making, assessment, and management by those in the same group practice, too, but don’t count clinical staff time.

For the medical record, the guidelines instruct you to keep permanent documentation, either electronic or hard copy.

Telephone Calls

Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

99441 (RVU 0.40)   5-10 minutes of medical discussion

99442 (RVU 0.78)  11-20 minutes of medical discussion

99443 (RVU 1.14)   21-30 minutes of medical discussion

Billing Requirements

Place of service for these codes is 02

Some payers may request a modifier and there can be some confusion as to which one. Note the 2 below though GT is not applicable but is for reference to have clarity.

95 Modifier

Modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.”  

GT Modifier

GT modifier means “via interactive audio and video telecommunications systems” As of January 1, 2018, the GT modifier is only allowed on institutional claims billed under Critical Access Hospital (CAH) Method II since institutional claims do not use a POS code.