Online digital evaluation and management services

February 19th, 2020 / By Karla VonEschen, CPC, CPMA

Happy New Year and welcome to 2020! A new year brings new opportunities to start fresh, create new goals and, for medical coders, it means an abundance of new CPT codes. When reviewing all the new codes for 2020, I think the most intriguing new codes are for online digital E/M services. Telemedicine in general is not new, but there are some new codes for online digital Evaluation and Management services effective January 1, 2020.

First, a little background on the benefits of telemedicine. Think about the various reasons people don’t visit the doctor. Your first thought might be finances, but for many people a simple visit to the doctor can be a trying experience depending on their health and the location of the clinic. Telemedicine supports efforts to significantly improve the quality of health care by increasing accessibility and efficiency through reducing the need to travel, providing clinical support, overcoming geographic barriers, offering various types of communication devices and improving patient outcomes. In addition, telemedicine can contain physician costs and improve healthcare delivery to all segments of the population. It’s a win-win situation all around.

In January of this year, physicians will have the ability to bill and be reimbursed for patient initiated online E/M services. Here are the general requirements for codes 99421-99423 per CPT:

  • Services must be patient- initiated and performed by a physician or other qualified health care professional (QHP)
  • Services require evaluation, assessment, and management of the patient
  • The patient must be established, although the condition may be new
  • Services must be initiated through a HIPAA-complaint secure platform (EHR portal, secure email or other digital application)
  • If the patient initiates this online service within seven days after an E/M service for the same problem, these codes may not be billed
  • These may not be billed by surgeons during the global period

Additional requirements:

  • Physicians may report once per 7-day period for cumulative time.
  • The 7-day period begins when the physician or QHP initially answers the inquiry.
  • Codes billed are based on time: 5-10 minutes, 11-20 minutes, or 21 or more minutes
  • The encounter documentation must be stored permanently either electronically or by hard copy.

Knowledge about and appropriate use of these new codes may provide more revenue for your practice to the extent your payers cover these services, especially if you work at a rural clinic. As always, specific documentation by your physicians is important to support billing the service and to know which time-based code to use.

You can find additional guidance for these codes in the 2020 CPT manual. As we begin a new year and people act on their resolutions to find new ways to get healthy and seek remote access to care, getting to know the new digital E/M codes is worthwhile. Have a happy and healthy 2020!

Karla VonEschen is a coding analyst at 3M Health Information Systems.


Get a better understanding of the two Quality Payment Program (QPP) paths.