Otolaryngology Coding Alert

Question: I read that we can charge insurers for our physician's online consultations, such as e-mails to patients in lieu of after-hours phone calls. How should we bill this?


Tennessee Subscriber
Answer: You can bill for electronic communications with your established patients using 0074T (Online evaluation and management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient). CPT released 0074T in July 2004 as a category III code.

Good news: Some insurers have already agreed to pay up to $25 for each claim with 0074T. For instance, Blue Shield of California and BCBS of Tennessee reimburse for online E/M services. These insurers maintain their own coverage guidelines. Other payers, such as Aetna and AFLAC, do not yet cover these services.

Important: According to CPT guidelines, if you report 0074T, you must permanently store the records. CPT's notes describing an online medical evaluation (0074T) state that the services -must involve permanent storage (electronic or hard copy) of the encounter.- And you should include all communication including telephone calls, prescriptions, and laboratory orders pertaining to the encounter in your documentation.