Six new CPT® codes for 2020 reflect the growth of non-visual digital evaluation services, that is, electronic health records and patient portals.
What’s more, for the first time, the CPT code set for 2020 will include two codes to support self-measured blood pressure monitoring.
The CPT Editorial Panel “agreed that the expanded use of electronic health records and associated, HIPAA-complaint secure patient portals has renewed focus on the important role played by non-visual digital patient-physician communication (i.e. e-visits),” Mark Synovec, M.D., chair of the CPT Editorial Panel, told Repertoire in an email.
Three of the new codes – 99421, 99422, 99423 – describe patient-initiated digital communications provided by a physician or other qualified healthcare professional. Three additional codes – 98970, 98971, 98972 – describe services provided by a non-physician healthcare professional.
2020 is not the first year that CPT codes have addressed online evaluation and management services. Since 2008, CPT codes 99444 and 98969 have described such services.
But “these codes were not widely adopted by payers due to a lack of clear definitions surrounding the work involved in these online visits,” said Synovec. “Furthermore, the current online evaluation and management codes did not fully characterize the evolution that has occurred with these services.”
With the CPT codes will come coverage, said Synovec. In its Proposed Rule for 2020, the Centers for Medicare & Medicaid Services proposed assigning RVUs, or relative value units, to codes 99421, 99422 and 99423, he said. Many private payers will follow Medicare’s lead, he added.
The agency has proposed that the non-physician healthcare professional codes (98970, 98971, 98972) be covered through HCPCS G-codes, for services and procedures that are under review for coverage. “[T]he Panel will be working to revise these CPT codes to try and meet the requirements of Medicare in 2020.”
Self-measured BP monitoring
Prior to 2020, the CPT code set never included self-measured blood pressure monitoring (SMBP), said Synovec. Four ambulatory blood pressure monitoring codes (93784, 93786, 93788, 93790) exist, but they only describe continuous monitoring over at least 24 hours.
“These new SMBP codes are more closely aligned with clinical guidelines that have shown the advantage of collecting blood pressure outside of the clinic setting for diagnosis of hypertension, which can result in measurement errors, a smaller number of measurements, and white coat hypertension,” he said. They are congruous with recent recommendations by the United States Preventive Services Task Force, which found that SMBP is a valid alternative method of confirmation when other methods are not available.
Current Procedural Terminology (CPT) codes offer doctors and healthcare professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency. They are also used for administrative management purposes, such as claims processing and developing guidelines for medical care review.
The CPT code set is maintained, updated and modified by the CPT Editorial Panel, with authorization of the AMA Board of Trustees. The panel is composed of 17 members. Of these, 11 are physicians nominated by the national medical specialty societies and approved by the AMA Board of Trustees. One of the 11 is reserved for expertise in performance measurement. One physician is nominated from each of the following: Blue Cross and Blue Shield Association, America’s Health Insurance Plans, American Hospital Association, and CMS. The remaining two seats on the panel are reserved for members of the CPT Health Care Professionals Advisory Committee.
New CPT codes
E-visits
Code Description
| 99421 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes |
| 99422 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes |
| 99423 | 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 |
| 98970 | Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes |
| 98971 | Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes |
| 98972 | Qualified nonphysician health care professional 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 |
Self-measured BP monitoring
Code Description
| 99473 | Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration |
| 99474 | Separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient |
Source: AMA