Can Providers Bill for Electronic Messages?

As a healthcare provider, you may be wondering if you can bill for electronic messages. The answer, which may surprise you, is yes – assuming the messages meet certain criteria. 

So, which electronic messages qualify and how do you appropriately bill them? The following criteria must be met:

• The patient must initiate the communication through a HIPAA-compliant, secure platform; for example, an EHR portal, secure email, or a digital app that allows communication with the provider.
• Time is cumulative over a 7-day period and begins when the physician or qualified healthcare provider (QHP) personally reviews the inquiry. Time may include review of the initial inquiry and review of the patient’s records or data pertaining to the assessment of the problem, and/or the provider’s interaction with clinical staff working on the patient's problem. It may also involve creating a treatment plan and all subsequent communication with the patient regarding the problem in the patient’s original communication as well as any professional decision making, assessment, or management by any other physician/QHP in the same group.
• Though the patient must be established, the problem in the communication can be new to the physician.
• Lastly, online digital E/M services require permanent documentation storage, either electronic or hard copy, of the encounter.

Now that we understand the basic criteria for billing electronic messages, let’s explore a couple examples.

Scenario 1
A patient generates an online inquiry for a new problem within 7 days of a previous E/M visit that addressed a different problem. In this case, the online digital visit, or message, can be billed separately. 

Scenario 2
If that same patient presents a new, unrelated problem within the 7-day period of an online digital inquiry, the physician/QHP’s time spent on the new problem should be added to the cumulative time of the original online digital inquiry for that 7-day period. 

Billable CPT services for electronic messages include 99421 (5-10 minutes), 99422 (11-20 minutes), and 99423 (21 or more minutes).

On the flip side, certain electronic messages are not billable. These include communication of test results, scheduling appointments, or other messages that do not include evaluation and management. If an online inquiry is initiated within 7 days of a previous E/M visit for the same problem, then the online digital visit is not reportable. Lastly, if an online inquiry is related to a surgery or procedure and occurs during the post-op period, then the online digital visit should not be billed.

Still have questions about billing for electronic messages? Our team of experts can help. Contact us today to schedule a discussion.