How To Use CPT Code 98971

CPT 98971 describes the online digital assessment and management services provided by a qualified nonphysician healthcare professional to an established patient for up to 7 days. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 98971?

CPT 98971 can be used to describe the online digital assessment and management services provided by a qualified nonphysician healthcare professional to an established patient. This code covers a cumulative time of 11 to 20 minutes spent with the patient over a period of up to 7 days.

2. Official Description

The official description of CPT code 98971 is: ‘Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes.’

3. Procedure

1. A qualified nonphysician healthcare professional communicates with an established patient via online communication technologies to address a health issue.
2. During the encounter, the healthcare professional responds to the patient’s health concerns, answers any medical questions, and recommends management.
3. The healthcare professional documents the encounter in the patient’s record and may follow up via telephone or email.
4. CPT code 98971 should be reported for a cumulative time of 11 to 20 minutes spent in communication with the patient over a 7-day period.

4. Qualifying circumstances

CPT 98971 is applicable when a qualified nonphysician healthcare professional communicates with an established patient via online communication technologies to address a health issue. The patient must have been seen by the same provider or any provider in a group practice within the past 36 months. The code covers a cumulative time of 11 to 20 minutes spent in communication with the patient over a 7-day period.

5. When to use CPT code 98971

CPT code 98971 should be used when a qualified nonphysician healthcare professional provides online digital assessment and management services to an established patient for a cumulative time of 11 to 20 minutes over a 7-day period. It is important to ensure that the patient meets the qualifying circumstances and that the time spent falls within the specified range.

6. Documentation requirements

To support a claim for CPT 98971, the healthcare professional must document the following information:

• Established patient status
• Online communication regarding the health issue
• Date and duration of each communication session
• Topics discussed and recommendations made
• Follow-up actions, if any
• Documentation of any additional services provided during the 7-day period

7. Billing guidelines

When billing for CPT 98971, ensure that the healthcare professional providing the service is a qualified nonphysician professional. The code should be reported for a cumulative time of 11 to 20 minutes spent in communication with the patient over a 7-day period. It is important to note that CPT code 98971 should not be reported if 5 to 10 minutes or 21 or more minutes of cumulative time are spent in communication with the patient over the same 7-day period. Check with individual insurance companies for specific guidelines and remember to document all relevant information.

8. Historical information

CPT 98971 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Examples

1. A nurse practitioner communicates with an established patient via online communication technologies to discuss the management of their chronic condition for a cumulative time of 15 minutes over a 7-day period.
2. A physical therapist provides online guidance and exercises to an established patient recovering from a musculoskeletal injury for a cumulative time of 18 minutes over a 7-day period.
3. A registered dietitian communicates with an established patient via email to provide nutritional recommendations and answer questions for a cumulative time of 13 minutes over a 7-day period.
4. A social worker conducts online counseling sessions with an established patient to address their mental health concerns for a cumulative time of 16 minutes over a 7-day period.
5. A physician assistant communicates with an established patient via video conference to review their medication regimen and provide guidance for a cumulative time of 19 minutes over a 7-day period.
6. A respiratory therapist provides online education and support to an established patient with a respiratory condition for a cumulative time of 14 minutes over a 7-day period.
7. A nurse communicates with an established patient via secure messaging to address their questions and concerns about their recent surgery for a cumulative time of 17 minutes over a 7-day period.
8. A mental health counselor conducts online therapy sessions with an established patient for a cumulative time of 12 minutes over a 7-day period.
9. A diabetes educator communicates with an established patient via a telehealth platform to provide guidance on blood glucose monitoring and insulin administration for a cumulative time of 20 minutes over a 7-day period.
10. A physical therapist provides online consultations and recommendations for an established patient with mobility issues for a cumulative time of 11 minutes over a 7-day period.