How To Use CPT Code 99422

CPT 99422 refers to online digital evaluation and management services for established patients, covering 11-20 minutes of cumulative time over a 7-day period. This article will discuss the code’s description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and provide examples.

1. What is CPT 99422?

CPT 99422 is a medical billing code used to describe online digital evaluation and management services provided by a physician or other qualified healthcare professional to an established patient. The code covers a cumulative time of 11-20 minutes spent in communication with the patient over a 7-day period. This service typically involves discussing a health issue, possible treatment, or management using online communication technologies.

2. 99422 CPT code description

The official description of CPT code 99422 is: “Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes.”

3. Procedure

The 99422 procedure involves the following steps:

1. The physician or qualified healthcare professional initiates an online communication with the established patient.
2. The healthcare professional discusses the patient’s health issue, answers any medical questions, and recommends management or treatment options.
3. Any necessary prescriptions, lab orders, or additional services are provided during the communication.
4. The healthcare professional documents the encounter in the patient’s medical record.
5. Follow-up communication may occur via telephone or email to address any additional questions or concerns.

4. Qualifying circumstances

Eligibility for CPT code 99422 services includes the following criteria:

• The patient must be an established patient of the physician or qualified healthcare professional providing the service.
• The service must be provided using online communication technologies, such as secure messaging or video conferencing.
• The cumulative time spent in communication with the patient must be between 11 and 20 minutes over a 7-day period.
• The service must involve discussing a health issue, possible treatment, or management options.

5. When to use CPT code 99422

It is appropriate to bill the 99422 CPT code when the following conditions are met:

• The patient is an established patient of the physician or qualified healthcare professional.
• The service is provided using online communication technologies.
• The cumulative time spent in communication with the patient is between 11 and 20 minutes over a 7-day period.
• The service involves discussing a health issue, possible treatment, or management options.

6. Documentation requirements

To support a claim for CPT 99422, the following information must be documented:

• The patient’s name and date of service.
• A description of the online communication technology used for the service.
• The total cumulative time spent in communication with the patient over the 7-day period.
• A summary of the health issue, possible treatment, or management options discussed during the service.
• Any prescriptions, lab orders, or additional services provided during the communication.
• Documentation of the encounter in the patient’s medical record.

7. Billing guidelines

When billing for CPT code 99422, keep the following guidelines in mind:

• Ensure that the patient is an established patient of the physician or qualified healthcare professional providing the service.
• Verify that the service was provided using online communication technologies.
• Confirm that the cumulative time spent in communication with the patient is between 11 and 20 minutes over a 7-day period.
• Document the encounter in the patient’s medical record, including the health issue, possible treatment, or management options discussed.
• Follow any additional billing rules or tips specific to your practice or payer.

8. Historical information

CPT 99422 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Similar codes to CPT 99422

Five similar codes to CPT 99422 include:

• CPT 99421: Covers online digital evaluation and management services for established patients with a cumulative time of 5-10 minutes over a 7-day period.
• CPT 99423: Covers online digital evaluation and management services for established patients with a cumulative time of 21 or more minutes over a 7-day period.
• CPT 99441: Telephone evaluation and management service provided by a physician to an established patient, covering 5-10 minutes of medical discussion.
• CPT 99442: Telephone evaluation and management service provided by a physician to an established patient, covering 11-20 minutes of medical discussion.
• CPT 99443: Telephone evaluation and management service provided by a physician to an established patient, covering 21-30 minutes of medical discussion.

10. Examples

Here are 10 detailed examples of CPT code 99422 procedures:

1. A physician provides online consultation to an established patient regarding their chronic pain management, discussing medication adjustments and alternative therapies over a 7-day period, totaling 15 minutes of communication.
2. An endocrinologist discusses blood sugar management and insulin adjustments with an established diabetic patient through secure messaging, totaling 18 minutes of communication over a 7-day period.
3. A psychiatrist conducts a video conference with an established patient to discuss their anxiety symptoms and medication adjustments, totaling 20 minutes of communication over a 7-day period.
4. A cardiologist provides online consultation to an established patient regarding their high blood pressure management, discussing medication changes and lifestyle modifications over a 7-day period, totaling 12 minutes of communication.
5. A gastroenterologist discusses treatment options and dietary changes with an established patient experiencing irritable bowel syndrome symptoms through secure messaging, totaling 17 minutes of communication over a 7-day period.
6. A dermatologist conducts a video conference with an established patient to evaluate a skin condition and recommend treatment options, totaling 15 minutes of communication over a 7-day period.
7. An allergist provides online consultation to an established patient regarding their allergy symptoms and medication adjustments, discussing potential triggers and management strategies over a 7-day period, totaling 19 minutes of communication.
8. A rheumatologist discusses treatment options and medication adjustments with an established patient experiencing arthritis symptoms through secure messaging, totaling 11 minutes of communication over a 7-day period.
9. A neurologist conducts a video conference with an established patient to discuss their migraine symptoms and medication changes, totaling 14 minutes of communication over a 7-day period.
10. An oncologist provides online consultation to an established patient regarding their cancer treatment plan, discussing potential side effects and management strategies over a 7-day period, totaling 20 minutes of communication.