The providers in our clinic want to start billing e-visits. Can they bill for all the communication between the provider and patient through our online portal?
Q: The providers in our clinic want to start billing e-visits.Can they bill for all the communication between the provider and patient through our online portal?
A: As you venture into billing e-visits, on-line visits, digital visits – however you’d like to refer to them – let’s review the required elements for these types of services. E-visits are utilized specifically for responding to patient-initiated health concerns and medical questions, and a provider’s management of the patient’s care utilizing communication through a patient portal.While on-line communication is utilized more and more, e-visits should not be utilized for simply disseminating test results, processing medication requests, or scheduling an appointment. An Evaluation and Management service (E/M) needs to be performed in order to bill for the service.
In other words, the provider is making a clinical decision that typically would have been provided in the office (eg, medication dose adjustment, ordering of a test, or prescription of a new medication).
Below are the Do's and Don’ts of billing these types of visits.
Can bill an E-visit when ALL of the following are met:
Exception: If within 7 days of a previous E/M visit that addressed a different problem, the patient sends an initial online digital inquiry for a new problem, the online digital E/M service may be reported separately.When multiple online E/M services addressing different problems occur within a 7-day period, report the cumulative time of service for all problems addressed.This could mean that your billing department should hold the initial e-visit for seven days to ensure all of the time is captured for that period.
Do not bill an E-visit when:
E-visit Codes to know
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
99422: 11-20 minutes
99423: 21 or more minutes
99421 - A mother submits an online query through her child’s physician’s electronic health record (EHR) portal about her 6-year-old son who developed an itchy rash two days after an outdoor hike.
Physician time spent: 7 minutes
99422 - A 75-year-old female with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) submits an online query through her physician’s EHR portal about worsening shortness of breath and mild weight gain.
Time spent by physician: 16 minutes
99423 - An adult child of an 80-year-old parent submits through her parent’s physician’s EHR portal an online query about her parent, who has moderate dementia and has become increasingly confused.
Time spent by physician: 30 minutes
The complexity of the patient’s issues would normally determine the time needed to respond.In each of these examples, the provider should document the total time spent performing any of the following activities in response to the patient inquiry:
Renee Dowling is a compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.