Updates to E/M guidelines will reflect modern health care

July 1, 2019 / By Rebecca Caux-Harry

In the morning, while getting ready for work, I listen to the radio. It’s the same program I’ve listened to for over 20 years. Normally, I “tune out” when commercials come on, but recently a commercial caught my attention. This commercial claimed that a person can purchase a generic version of the “little blue pill” online, have it delivered to their house all without having to go to a doctor. This last claim is what caught my attention and I got to wondering how this company can dispense or sell prescription medications without a prescription. My interest in the commercial ends here, but it did cause me to think about telehealth reporting.

CMS has been working toward updating their policies to reflect advancements in the way health care is provided. The biggest change I saw was the update to E/M documentation and coding guidelines that will come in 2021. The removal of the requirement of face-to-face time between physician and patient to seek reimbursement is a welcome one. We’ve always had, at least as long as I can remember, codes to reflect non-face-to-face services, but they weren’t reimbursed by Medicare or most commercial payers. That has changed. The telehealth codes reflect physician interactions with each other or with patients in remote locations and are now reimbursed.

CPT codes 99446-99449 were updated this year to include “electronic health record” in their descriptors to reflect current medical practice. These codes report Interprofessional assessment and management by a consultative physician of a patient’s medical condition and require both a verbal and written report to the treating physician. The codes are time-based. New this year are codes 99451 and 99452.

99451   Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time

99452   Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes

The difference between the codes is that the new codes lack the requirement of a verbal report. CMS expects us to use these codes to report a consultation via a shared electronic health record or other non-verbal communication. These codes report the work done between two providers. 

Codes reflecting non-face-to-face services between a patient and a physician include a few G codes;

               G2012 for a virtual check-in

               G2010 for remote evaluation of pre-recorded patient information

Both codes were created with the hope of easing communication between patient and provider and reducing unnecessary office visits. CMS stipulates that these codes are only reportable by providers who can furnish E/M services.

Additionally, we have codes for prolonged preventive services, G0513 and G0514, as well as codes for remote physiologic monitoring (99453, 99454 and 99457) and chronic care management (99490 and 99491). These codes are time, frequency, provider and condition requirements.

The Center for Connected Health Policy has created a variety of fact sheets about the updates to telehealth polices which can be found here. In short, we have a variety of new and updated codes to report the current practice of medicine and to ease some of the burden placed on both physicians and very sick patients (although I don’t believe any of these codes are appropriate for the weird commercial I hear some mornings).

Rebecca Caux-Harry, CPC, is a professional fee coding specialist with 3M Health Information Systems.