How To Use CPT Code 98972

CPT 98972 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 98972?

CPT 98972 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 21 or more minutes spent with the patient over a period of up to 7 days. The services are conducted through online communication technologies, such as email or other electronic means.

2. Official Description

The official description of CPT code 98972 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; 21 or more minutes.’

3. Procedure

1. The nonphysician healthcare professional communicates with the established patient via online communication technologies, such as email or other electronic means.
2. During the online encounter, the healthcare professional addresses the patient’s health issue, provides possible treatment or management options, and responds to any medical questions the patient may have.
3. The healthcare professional may recommend management strategies, prescribe medications, order lab tests, or provide any other necessary guidance to the patient.
4. The encounter is documented in the patient’s record, and follow-up communication may occur via telephone or email.
5. CPT code 98972 should be reported for a cumulative time of 21 or more minutes spent in communication with the patient over a 7-day period.

4. Qualifying circumstances

CPT 98972 is applicable when a qualified nonphysician healthcare professional provides online digital assessment and management services to an established patient. The patient must have been seen by the same provider or any provider in a group practice within the past 36 months. The communication must address a health issue, and the cumulative time spent in communication with the patient over a 7-day period must be 21 minutes or more.

5. When to use CPT code 98972

CPT code 98972 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 21 or more minutes over a 7-day period. It is important to note that this code should not be reported for cumulative visit time less than 5 minutes. Additionally, CPT code 98972 should not be reported when using other codes such as 99091, 99374, 99375, 99377, 99378, 99379, 99380, 99426, 99427, 99437, 99439, 99487, 99489, 99490, or 99491 for the same communication.

6. Documentation requirements

To support a claim for CPT 98972, the healthcare professional must document the following information:

• Established patient status
• Date and time of each online communication
• Cumulative time spent in communication with the patient over a 7-day period
• Details of the health issue discussed and any treatment or management recommendations provided
• Documentation of any prescriptions, lab orders, or other actions taken during the online encounter
• Follow-up communication, if any, via telephone or email

7. Billing guidelines

When billing for CPT 98972, ensure that the healthcare professional providing the service is a qualified nonphysician professional. The cumulative time spent in communication with the patient over a 7-day period must be 21 minutes or more. It is important to note that CPT code 98972 should not be reported with other codes such as 98970, 98971, or 98972. Additionally, it should not be reported for home and outpatient INR monitoring when reporting code 93792 or 93793.

8. Historical information

CPT 98972 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 providing online digital assessment and management services to an established patient for a cumulative time of 25 minutes over a 7-day period to address their chronic pain management.
2. A physician assistant communicating with an established patient via email for a cumulative time of 30 minutes over a 7-day period to discuss their medication management for hypertension.
3. A physical therapist providing online digital assessment and management services to an established patient for a cumulative time of 40 minutes over a 7-day period to guide them in their exercises for post-surgery rehabilitation.
4. A nurse providing online digital assessment and management services to an established patient for a cumulative time of 21 minutes over a 7-day period to address their questions and concerns about their diabetes management.
5. A respiratory therapist communicating with an established patient via online means for a cumulative time of 35 minutes over a 7-day period to provide guidance on their asthma management.
6. A nurse practitioner providing online digital assessment and management services to an established patient for a cumulative time of 27 minutes over a 7-day period to discuss their anxiety management techniques.