Part 2
There are no specific CPT codes for telehealth services provided by chiropractors. However, it is possible that some payers might allow billing a therapy code such as 97110 with the 95 modifer and the 02 place of service code. This assumes that the same criteria for medical necessity have been satisfied as at a live encounter and the documentation is complete.
Some new codes were added as of 1/1/2020 for online digital E/M services. They vary in value from $16 to about $55 for Medicare. Private payer reimbursement would be higher. They are:
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 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
99423 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
The AMA guidelines are as follows:
Online digital evaluation and management (E/M) services (99421, 99422, 99423) are patient-initiated services with physicians or other qualified health care professionals (QHPs). Online digital E/M services require physician or other QHP’s evaluation, assessment, and management of the patient. These services are not for the nonevaluative electronic communication of test results, scheduling of appointments, or other communication that does not include E/M. While the patient’s problem may be new to the physician or other QHP, the patient is an established patient. Patients initiate these services through Health Insurance Portability and Accountability Act (HIPAA)-compliant secure platforms, such as electronic health record (EHR) portals, secure email, or other digital applications, which allow digital communication with the physician or other QHP.
Online digital E/M services are reported once for the physician’s or other QHP’s cumulative time devoted to the service during a seven-day period. The seven-day period begins with the physician’s or other QHP’s initial, personal review of the patient-generated inquiry. Physician’s or other QHP’s cumulative service time includes review of the initial inquiry, review of patient records or data pertinent to assessment of the patient’s problem, personal physician or other QHP interaction with clinical staff focused on the patient’s problem, development of management plans, including physician- or other QHP generation of prescriptions or ordering of tests, and subsequent communication with the patient through online, telephone, email, or other digitally supported communication, which does not otherwise represent a separately reported E/M service. All professional decision making, assessment, and subsequent management by physicians or other QHPs in the same group practice contribute to the cumulative service time of the patient’s online digital E/M service. Online digital E/M services require permanent documentation storage (electronic or hard copy) of the encounter.
If within seven days of the initiation of an online digital E/M service, a separately reported E/M visit occurs, then the physician or other QHP work devoted to the online digital E/M service is incorporated into the separately reported E/M visit (eg, additive of visit time for a time- based E/M visit or additive of decision-making complexity for a key component-based E/M visit). This includes E/M visits and procedures that are provided through synchronous telemedicine visits using interactive audio and video telecommunication equipment, which are reported with modifier 95 appended to the E/M service code. If the patient initiates an online digital inquiry for the same or a related problem within seven days of a previous E/M service, then the online digital visit is not reported. If the online digital inquiry is related to a surgical procedure and occurs during the postoperative period of a previously completed procedure, then the online digital E/M service is not reported separately. If the patient generates the initial online digital inquiry for a new problem within seven days of a previous E/M visit that addressed a different problem, then the online digital E/M service may be reported separately. If the patient presents a new, unrelated problem during the seven-day period of an online digital E/M service, then the physician’s or other QHP’s time spent on evaluation, assessment, and management of the additional problem is added to the cumulative service time of the online digital E/M service for that seven-day period.
The online digital evaluation and management (E/M) services are intended for patient-initiated digital communications that require a clinical decision that would have otherwise have been typically provided in the office. These services provide a clinician the opportunity to gather information through, for example, review of patient records and to develop a diagnosis and possible management plan. These services are not intended to represent the nonevaluated electronic communication that may be solely focused on dissemination of test results, processing of medication requests or scheduling of appointments.
If this applies to the services you provide, you might consider reporting them. Though it may seem like it has limited application in a chiropractic setting, patients could be better served, and the provider may be able to generate additional revenue by following the scenario outlined above. Check with private payers and your state board to make sure you can bill for these services.
