How To Use CPT Code 99423

CPT 99423 is an online digital evaluation and management service for established patients, covering 21 or more minutes of cumulative time over a 7-day period. This article will discuss the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99423.

1. What is CPT 99423?

CPT 99423 is a code used to report online digital evaluation and management services provided by a physician or other qualified healthcare professional to an established patient. This code covers a cumulative time of 21 or more minutes spent in communication with the patient over a 7-day period. The purpose of this code is to ensure proper billing and reimbursement for healthcare professionals who provide these services to their patients.

2. 99423 CPT code description

The official description of CPT code 99423 is: “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.”

3. Procedure

1. The physician or other qualified healthcare professional initiates an online communication with the established patient.
2. The healthcare professional addresses the patient’s health concerns, answers medical questions, and recommends management options.
3. The healthcare professional documents the encounter in the patient’s medical record.
4. Follow-up communication may occur via phone or email to address any additional questions or concerns.
5. The total cumulative time spent in communication with the patient over the 7-day period is calculated and documented.
6. If the cumulative time is 21 or more minutes, CPT 99423 is reported for billing purposes.

4. Qualifying circumstances

Eligibility for CPT code 99423 services includes established patients who require online digital evaluation and management services from a physician or other qualified healthcare professional. The patient must have an existing relationship with the healthcare professional, and the service must be provided over a 7-day period with a cumulative time of 21 or more minutes spent in communication.

5. When to use CPT code 99423

It is appropriate to bill CPT code 99423 when a physician or other qualified healthcare professional provides online digital evaluation and management services to an established patient, with a cumulative communication time of 21 or more minutes over a 7-day period. This code should not be used for cumulative service times less than 21 minutes or for services provided to new patients.

6. Documentation requirements

To support a claim for CPT 99423, the following information should be documented:

• Patient’s name and date of service
• Established patient status
• Details of the online communication, including the mode of communication (e.g., email, secure messaging)
• Health concerns, questions, and management recommendations discussed during the encounter
• Total cumulative time spent in communication with the patient over the 7-day period
• Any follow-up communication or actions taken

7. Billing guidelines

When billing for CPT code 99423, it is important to follow the appropriate guidelines and rules. Some key points to consider include:

• Report CPT 99423 only once per 7-day period.
• Do not count clinical staff time as part of the cumulative time for CPT 99423.
• Do not report CPT 99423 on a day when the physician or other qualified healthcare professional reports E/M services.
• Do not report CPT 99423 when using certain other codes for the same communication(s).

8. Historical information

CPT 99423 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 99423

Five similar codes to CPT 99423 include:

• CPT 99421: Online digital evaluation and management service for established patients, covering 5 to 10 minutes of cumulative time over a 7-day period.
• CPT 99422: Online digital evaluation and management service for established patients, covering 11 to 20 minutes of cumulative time over a 7-day period.
• CPT 99441: Telephone evaluation and management service provided by a physician to an established patient, covering 5 to 10 minutes of medical discussion.
• CPT 99442: Telephone evaluation and management service provided by a physician to an established patient, covering 11 to 20 minutes of medical discussion.
• CPT 99443: Telephone evaluation and management service provided by a physician to an established patient, covering 21 to 30 minutes of medical discussion.

10. Examples

Here are 10 detailed examples of CPT code 99423 procedures:

1. A physician provides online management recommendations for an established patient’s chronic pain condition over a 7-day period, with a cumulative communication time of 25 minutes.
2. An endocrinologist discusses diabetes management with an established patient through secure messaging, totaling 30 minutes of communication over a 7-day period.
3. A psychiatrist provides online counseling and medication management for an established patient with anxiety, with a cumulative communication time of 35 minutes over a 7-day period.
4. A cardiologist reviews an established patient’s blood pressure readings and provides recommendations for medication adjustments, with a cumulative communication time of 22 minutes over a 7-day period.
5. A gastroenterologist discusses treatment options for an established patient’s irritable bowel syndrome through email, totaling 28 minutes of communication over a 7-day period.
6. A neurologist provides online management recommendations for an established patient’s migraine headaches, with a cumulative communication time of 23 minutes over a 7-day period.
7. An allergist reviews an established patient’s allergy symptoms and provides recommendations for medication adjustments, with a cumulative communication time of 27 minutes over a 7-day period.
8. A rheumatologist discusses treatment options for an established patient’s rheumatoid arthritis through secure messaging, totaling 32 minutes of communication over a 7-day period.
9. A dermatologist provides online management recommendations for an established patient’s eczema, with a cumulative communication time of 24 minutes over a 7-day period.
10. An oncologist discusses treatment options for an established patient’s cancer through email, totaling 36 minutes of communication over a 7-day period.