Cracking the Codes: Telemedicine Rolls Forward

Change is the only constant in life. Changes for 2020 include new codes for digital evaluation and management (E/M), but we will have to wait for 2021 for major overhauls in how we select our office visit E/Ms.

The three new online digital E/M codes are effective immediately and should help usher in the era of teledermatology. They include:

99421. This is the code for online digital evaluation and management service for an established patient for up to seven days. The cumulative time during the seven days is five to 10 minutes.

99422. This is the code for online digital evaluation and management service for an established patient for up to seven days. The cumulative time during the seven days is 11-20 minutes.

99423. This is the code for online digital evaluation and management service for an established patient for up to seven days. The cumulative time during the seven days is 21 or more minutes.

Coding Caveats

These codes have multiple provisions that we must meet to use them. For starters, they can only be used for established patients and must be patient-initiated through a HIPAA-compliant platform.

We won’t get reimbursed for administrative issues with these codes. They must be for a patient complaint that is unrelated to any complaint dealt with during an office visit within the last seven days. For example, if you saw a patient for a rash on Monday, the digital E/M code can’t be used to address this issue three days later. That said, if the same patient experiences an acne flare and seeks consult within this time frame, the new codes can be used.

In addition, if the patient concern deals with a surgical procedure and they are in the surgical global period, you can’t bill these codes.

The codes themselves also have a “built-in” global period, meaning if there is an online “conversation” with the patient over a seven-day period, you only report one code, but you can add up the amount of time. If you see the patient within seven days, you can add the time spent into your E/M calculation. (This may be more relevant in 2021 with new E/M paradigm.)

Teledermatology Takes Off

The two stumbling blocks to teledermatology have historically been lack of CPT codes and licensure. You must be licensed in the state where the patient resides to care for him or her. Taken together, the new codes and the Federation of State Medical Boards’ (FSMB) new Interstate Medical Licensure Compact tell us that telederm is poised for take off. The agreement is between 29 states, the District of Columbia, and the Territory of Guam. Licensed physicians can qualify to practice medicine across state lines within the Interstate Medical Licensure Compact if they meet the eligibility requirements. Once qualified, the physician may select any number of Compact states in which s/he desires to practice.