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Understanding the 2020 CPT Codes: A Focus on Digital Communication

For many of you, it already feels like winter, even if the season doesn’t officially start until December 21. Colder weather is expected this time of the year, as are lists ranking the biggest news stories and trends from the past 12 months. For healthcare professionals like you, this time of the year also brings an end to some of the Current Procedural Terminology (CPT) codes you’ve gotten used to using.

This fall, the American Medical Association (AMA) released its list of revisions to the CPT codes for 2020. Specifically, there are 394 total revisions to the list for next year, including 248 new codes, 75 revisions and 71 deletions. The new codes, six of which we’re going to highlight in this blog, take effect on January 1, 2020.

The Method Behind the Madness

Much of this probably isn’t news to you, but it’s important to know the reasons behind these new codes and the requirements that correspond with them. The primary objective of the six codes that are the focus of this blog is to document patient services that utilize digital communication tools. Technology keeps changing the healthcare industry, and these new codes reflect that.

For example, technologies such as patient portals and others used for patient-initiated electronic visits (e-visits) and remote patient monitoring enable physicians and other qualified clinicians to employ a HIPAA-compliant telehealth platform to perform services that previously had to be done in-office or in a hospital or similar healthcare facility. As we’ve discussed in a previous blog, focusing on SDOH is essential for improving health and reducing health disparities. Technology can help achieve that goal.

Digital Evaluation and Management

If part of the practice for which you work entails evaluation and management (E/M) services, these new codes are essential to know. The first three – 99421, 99422 and 99423 – are time-based codes. Here are the specifics: 

  • 99421 – Online digital evaluation and management service for an established patient for up to seven days, cumulative time during the seven days; 5-10 minutes. 
  • 99422 – 11—20 minutes 
  • 99423 – 21 or more minutes

Note that 99444, the code for online E/M service, has been removed for 2020.

Chronic Care Remote Physiologic Monitoring

Of the second three codes, the first one, 99458, was created as an add-on to 99457. As you may already know, 99457 covers 20 minutes of chronic care remote physiologic monitoring. The add-on simply should be used to report each additional 20 minutes of this service in the same calendar month. So, if you’re using the code 99458, it should be reported with 99457.

The remaining two codes – 99473 and 99474 – were initiated for practices to report self-measured blood pressure monitoring. According to AMA, the goal of these codes is to “expand reporting pathways for physicians across the country who take care of a diverse set of patients that have varying degrees of access to care.”

A List of Key Guidelines

The new codes for online digital E/M services come, of course, with certain requirements. Here is a list of them, courtesy of the American Academy of Pediatrics (AAP):

  • Patient must be established, while the problem being addressed may be new.
  • Patient must initiate the service through Health Insurance Portability and Accountability Act (HIPAA)-compliant secure platforms, such as electronic health record portals, secure email or other digital applications.
  • Codes can be reported once per seven-day period.
  • Time begins with the initial personal review of the patient-generated inquiry.
  • Time counted is spent in evaluation, professional decision-making, assessment and subsequent management.
  • Time is accumulated over the seven days and includes time spent by the original physician and any other physicians or other qualified health professionals (QHPs) in the same group practice who may contribute to the cumulative service time of the patient’s online digital E/M service.
    • Time does not include time spent on non-evaluative electronic communications including but not limited to scheduling appointments, referral notifications and test result notifications.
    • Permanent documentation storage (electronic or hard copy) of the encounter(s) is required.
    • If a separately reported E/M visit occurs within seven days of the initiation of an online digital E/M service, then the physician or other QHP work devoted to the online digital E/M service is incorporated into the separately reported E/M visit.
    • Do not report this service during a procedural global period.

Learn More About How These Codes May Affect Your Practice

Our director of clinical solutions, Erin Zielinski, is hosting a webinar on this topic. She’ll cover the new CPT codes and updates and documentation requirements and discuss a few of the new ICD-10 codes that have been released for 2020.