WebVisits 99444 vs Telecons 99441/2/3 --> Re: Telephone Consults - again -- codes, fees

[Guest guest]

Thanks, .When I was putting together the original email, I hadn't picked up on the 99444 being specifically for using the internet or similar electronic communication -- can anyone say - texting?I also pasted some past payments for various Telecons to give an idea of a price range for these codes.

99444 would match perfectly with the online patient portal consult.Of note, note completely clear, but the RVU for a 99444 seem to be more than for a 99441 - at least based on one source.      99441 – .39

     

99442 – .72      

99443 – 1.06      

99444 – .7299444 Online evaluation and management service provided by a

physician to an established patient, guardian or health care provider not

originating from a related E/M service provided within the previous 7 days,

using the Internet or similar electronic communications network I'm not sure where the RVU's from this website come from but...https://vmccohe.valleymed.org/FINAL%20COHE%20July%202009%20Fee%20schedule%28for%20distribution%29.pdf

RVU: 99441 – .39 99442 – .72 99443 – 1.06 99444 – .72=================================This is from 2008, but...http://www.familydocs.org/files/May08.pdf

Payment for Online Services:Non-payment by most health plans has been a major roadblock for expansion of the virtual office.Since some of the major insurers are now covering the service, however, it is expected that more will follow. Unfortunately, some smaller insurers that began paying for online consultations recently stopped doing so because few members used the service.

Pricing for the service varies, but should typically equate to your fee for a 99212 or 99213. When determining your fee, you want the fee to reflect the fact that you may have two or three related emails to complete the “visit”, but you’ll be billing it all as one service.

Just as fees vary, so does payment. Aetna and Cigna payment range from $26 to $32, depending upon geographic areas and individual contracts. Some pilot projects with Kaiser Permanente have reimbursed as high as $50/visit.

The Medicare program is still on the sidelines when it comes to payment. It is considered a noncovered item, however, as opposed to a bundled service, so Medicare beneficiaries can be billed directly for this service.

The same is true of Blue Shield of California. Anthem (Blue Cross of California) submits the service for medical review and then typically denies it for medical necessity, but if the patient has signed a waiver prior to participating in the service, you may be allowed to bill the patient directly.

==========================http://www.aap.org/visit/rbrvsbrochure.pdf=================

http://www.hawaiimda.org/storage/handouts/Hawai%20Billing%20and%20Coding%202010.pdfTelephone Calls• E/M codes / $$ established, not paid for by CMS

• Physician to patient, parent or guardian• E/M service not related to previous E/M service within 7 days or planned E/M service next 24 hours or soonest available appointment– CPT 99441 5-10 min $13.71 – 12.27

– CPT 99442 11-20 min $26.70 – 25.22– CPT 99443 21-30 min $38.97 – 37.81– CPT 99444 internet service, no time / $$• Can consider in care & coordination next visit now - carefully========================

http://www.ama-assn.org/amednews/2010/03/22/bica0322.htmHow to get paid for online consults

Technically Speaking. By Pamela Dolan, amednews staff. Posted March 22, 2010.

....according to CPT code 99444, certain criteria need to be met by practices when billing for online consults:

The code must not refer to a previous E & M service performed and

reported by the physician within the previous seven days, or within a postoperative recovery period. If it does, the service is considered part of the previous E & M service and cannot be recorded separately. The code should be recorded only once and encompass all of the communication related to that e-visit, including telephone calls, prescription medication provisions and lab orders. The visit must be made part of the patient record.=================http://www.memo-snap.com/memo-snap/online.htm

Medicare and many commercial plans have designated Online Medical Evaluations as Non-Covered, in which case you are free to bill for it. Physicians should contact their payers in order to determine possible conflicts or contract violations and should also confirm liability coverage with their malpractice carriers before providing this type of service.

CPT 99444 On-Line Medical Evaluation by a Physician

Online evaluation and management service provided by a physician to an established patient, guardian, or health care provider not originating from a related E/M service within the previous 7 days, using

the Internet or similar electronic communications network.

CPT 98969 On-Line Medical Evaluation by a Non-Physician

Online assessment and management service provided by a qualified non-physician health care professional to an established patient, guardian, or health care provider not originating from a related E/M service within the previous 7 days, using the Internet or similar electronic communications network.

Guidelines

Reportable services involve a personal and timely response to the patient’s inquiry, and must include permanent storage (electronic or

hard copy)The online encounter is reported only once for the same problem/issue during a seven-day period, and includes the sum of all communication related to the online encounter (eg telephone calls, prescriptions, lab orders).If the online encounter relates to and occurs within 7 days of another E/M service performed and reported by the same provider for the same problem, it is not separately reportable.If the online encounter relates to a procedure performed by the same physician and occurs during the global post-operative period, it is

not separately reportable.Online services should not be reported for care plan oversight or anticoagulation management when the same communication is reported using codes 99339-99340, 99374-99380, or 99363-99364.Online services which result in a face-to-face visit for the same problem may be reported in addition to the face-to-face visit.==================

Locke, MD