Don't have a TCI SuperCoder account yet? Become a Member >>

Ob-Gyn Coding Alert

Your Ob-Gyn's E-Mails Can Add $25 to Your Bottom Line

Find out if your payer is among those reimbursing 0074T If your ob-gyn interacts with patients by e-mail, you may be entitled to use Category III code 0074T -- but before you do, find out what you need to meet payer guidelines. Code 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 for Roger Rholdon, MD, in Hammond, La.
CPT released 0074T in July 2004 as a category III code. These temporary codes identify emerging technologies, procedures and clinical trials. Using this code allows the AMA and insurers to gather data about these services or procedures. Some Insurers Cover Online Communication Good news: Some insurers have already agreed to pay as much as $25 for each 0074T claim. For instance, Blue Shield of California and BCBS of Tennessee reimburse for the online E/M services. These insurers maintain their own coverage guidelines. BCBS of Tennessee, for example, requires the following criteria for 0074T payment:
1. Physician responds to the patient's request within 24 hours (except over the weekend, in which case he responds by end-of-day Monday).
2. And one or more of the following:
- Patient describes new symptoms and requests intervention and/or advice from physician to treat new symptoms.
- Patient describes ongoing symptoms from a recent acute problem or chronic health problem and requests intervention and/or advice from physician to treat said problem.
- Evidence that physician gives substantive medical advice, revises treatment plan, prescribes/revises medication, recommends additional testing, and/or provides self-care/patient education information for a new and/or chronic health problem.
- Evidence that physician makes a new diagnosis and prescribes new treatment.
- Patient requests interpretation of lab and/or test results with evidence that physician provides substantive explanation and possibly makes recommendations to modify treatment plan, revises medications, etc.
- Evidence that physician provides extended personal patient counseling that changes the course of treatment and impacts the potential health outcome. Aetna and AFLAC do not now reimburse 0074T claims, 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. NCCI Bundles Internet Encounter Into Visit You should also ask your insurer whether it has adopted the National Correct Coding Initiative's policy on the high-tech code. NCCI makes 0074T a component to every other E/M code (except 99499, Unlisted E/M service).
Translation: You [...]