Telephone and Patient Portal Virtual Encounters
There are codes for patient services using the telephone or online methods of communication, such as the patient portal, which are considered non-face-to-face services. The patient should provide verbal consent to the services, at least once a year and it’s recommended to document consent for each service you bill (don’t surprise the patient with a charge). Online methods should be HIPAA compliant and secure and telephone services should make reasonable attempts to protect privacy. All services and the time spent must be documented in the EHR.
Codes include physician time reviewing records, diagnosing and managing, ordering labs or other studies, and communicating with the healthcare team, however, these codes don’t include time spent by other clinical staff. It can be billed only once per 7 days and the time is cumulative over 7 days; e.g., if you speak with a patient for 4 minutes two times during the week, that would count as an 8 minute medical discussion and meet criteria to bill.
➔ Telephone Encounters:
● 99441 - Medical discussion by physician lasting 5-10 minutes
● 99442 - Medical discussion by physician lasting 11-20 minutes
● 99443 - Medical discussion by physician lasting 21-30 minutes
➔ Patient Portal Virtual Encounters (Online Digital Evaluation):
● 99421 - Medical discussion by physician lasting 5-10 minutes
● 99422 - Medical discussion by physician lasting 11-20 minutes
● 99423 - Medical discussion by physician lasting > 21 minutes
These codes have some caveats or exclusions:
1. For portal encounters, the patient should initiate the service by their own inquiry through the portal.
2. These codes shouldn't be used if the interaction results in a face-to-face visit within 7 days, including telemedicine services (if for the same problem). However, you can apply non face-to-face time and medical decision-making criteria, within 7 days, towards the face-to-face visit (office or telemedicine visit) and bill accordingly at the time of the face-to-face visit.
3. They also should’n’t be used if the interaction refers to a face-to-face visit for the same issue that occurred within the previous 7 day.
4. Likewise, these codes shouldn’t be used if they were used in that patient’s chart within the last 7 days.
5. There can be no double-dipping. They shouldn't be used if the patient is already being billed for home or domiciliary care plan oversight (99339 and 99340), other care-plan-oversight services (99339-99340, 99374-99380), remote INR management (93792, 93793), transitional care management (99495-99496), or when chronic-condition management codes are used monthly (99490 or 99491, 99439, 99437, 99487 or 99789). In other words, no double-dipping is allowed.