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Wiki Telehealth 99422

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tanderson@MCS

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Bakersfield, CA
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Can a provider bill 99214 and 99422 the same day and be payable for a Medicare member? I believe they 99422 bundles into 99214 and a modifier would not be appropriate.
 
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99214 and 99422 are typically not billable together.
Included in the guidelines on 99422:
If within seven days of the initiation of an online digital E/M service, a separately reported E/M visit occurs, then the physician or other QHP work devoted to the online digital E/M service is incorporated into the separately reported E/M visit (eg, additive of visit time for a time-based E/M visit or additive of decision-making complexity for a key component-based E/M visit). This includes E/M visits and procedures that are provided through synchronous telemedicine visits using interactive audio and video telecommunication equipment, which are reported with modifier 95 appended to the E/M service code. If the patient initiates an online digital inquiry for the same or a related problem within seven days of a previous E/M service, then the online digital visit is not reported. If the online digital inquiry is related to a surgical procedure and occurs during the postoperative period of a previously completed procedure, then the online digital E/M service is not reported separately. If the patient generates the initial online digital inquiry for a new problem within seven days of a previous E/M visit that addressed a different problem, then the online digital E/M service may be reported separately. If the patient presents a new, unrelated problem during the seven-day period of an online digital E/M service, then the physician's or other QHP's time spent on evaluation, assessment, and management of the additional problem is added to the cumulative service time of the online digital E/M service for that seven-day period.
 
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It's inclusive or bundled because a separately reported E/M service (99214) occurred within 7 days of the online digital E/M service (99422) for the same problem. Review the guidelines for online digital E/M services in the 2021 CPT manual, it gives a complete breakdown.
 
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