Thanks for your question.
There is no CCI edits between codes of these procedures but to report these, you need to know the following:
Code 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) has some significant restrictions, which stipulate that the service has to be:
- Provided to an established patient (or guardian),
- Provided by a physician or other qualified health care professional (QHP), and
- Unrelated to an E/M service provided within the previous seven days.
This means that any online digital E/M service that results from a previous visit or that results in a subsequent E/M visit is not separately reported, and the online E/M service is incorporated into the related E/M visit.
Also, CPT® has placed a seven-day cumulative time limitation on 99421 and made the code time-dependent. You will be able to use 99421 if your provider spends between 5 and 10 minutes on any asynchronous communications with the patient in that time; you will also be able to report longer time increments with new codes 99422 (… 11-20 minutes) or 99423 (… 21 or more minutes).
Coders will need to work with their providers to ensure that they are documenting the time factors of the new codes.
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; 5-10 minutes)
98971 (… 11-20 minutes)
98972 (… 21 or more minutes).
These new codes mimic the qualified nonphysician health care professional [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.
Lastly, coders will need to work with their providers to figure out how the provider is going to track the time over the 7 days and report the appropriate code when the 7 days are up. Consequently, coders should check with the payers to whom they submit claims most often to learn how those payers intend to handle these codes.Remote Evaluations, Virtual Check-Ins & E-Visits
Medicare patients may have a brief communication service with practitioners via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. Clinicians can provide remote evaluation of patient video/images and virtual check-in services (HCPCS codes G2010, G2012) to both new and established patients. These services were previously limited to established patients.
Please feel free to write if you have any question.