New, Revised CPT Codes Target Online, Telephone Services

Recent changes in CPT codes for non-face-to-face physician services could help turn the tide against payers' long-standing reluctance to pay physicians for telephone and online patient consultations.

The new -- and, in some cases, revised -- CPT codes took effect on Jan. 1 and represent the culmination of several years of teamwork by the AAFP; the American College of Physicians; and the American Academy of Pediatrics, or AAP.

David Ellington, M.D., of Lexington, Va., served as the Academy's representative to the AMA's CPT Advisory Committee. He credited the AAP with taking the lead on introducing the original proposal to the AMA's CPT Editorial Panel, and said the updates were, in effect, "recognition of changing communication patterns between physicians and patients."

Ellington, who also is a member of the AAFP's Board of Directors, said the CPT Advisory Committee recognized that today's patients were well-informed, educated and accustomed to using electronic sources to gather and transfer information. "They're also more likely to demand convenient and timely access to medical care, including non-face-to-face services, such as advice by e-mail and telephone," wrote the committee.

Physicians can use three new telephone service codes -- 99441, 99442 and 99443 -- when they are reporting medical care via telephone that is initiated by an established patient or by the patient's guardian. The reporting physician, or a physician of the same specialty in the same practice, must have seen the patient within the past three years.

The CPT codes for telephone services are based on the amount of time the physician spends discussing medical matters with the patient or guardian. The time increments are

The old telephone codes -- 99371, 99372 and 99373 -- have been deleted.

CPT code 99444 is available to physicians for billing for online patient services. The service can be reported only once for the same episode of care in a seven-day period and includes all other communications stemming from the online encounter, including follow-up telephone calls and pharmacy, lab and imaging orders.

Review "CPT 2008: A Glimpse of the Future of Family Medicine?" in the January issue of Family Practice Management or the AMA's CPT 2008 manual for additional details on appropriate use of the codes.

Ellington broadened the significance of the new codes. "The most exciting aspect of the inclusion of these codes into the CPT book is the manner in which this can be integrated into the patient-centered medical home process," said Ellington. "The ability to use the technology of today to improve patient care -- and to get paid for it -- is fundamental to both the success of the medical home and to the transition to the modern practice model that the Academy seeks."

Billing for these services with an accurate CPT code does not ensure payment, however. "At the present time, Medicare does not pay for these any of these codes," noted Ellington.

However, two of the country's largest health insurers -- Aetna and CIGNA HealthCare -- already are paying some physicians for online patient consultations. The two companies have teamed up with RelayHealth, a connectivity company based in Atlanta that lets physicians engage in online patient consultations, electronic prescribing and more.

In fact, late in 2007, CIGNA announced that it would expand a four-state pilot program nationally to employers with self-insured health plans. At virtually the same time, Aetna announced that it would increase its online communications services to include more than 30 medical specialty categories in most of Aetna's medical plans nationwide.

According to information from RelayHealth, those two large insurers, as well as 11 additional health plans, are offering their members secure online consultations. Health plans establish payment rates for their participating physicians and copays for their members.

"This 'virtual office visit' is an easy, convenient, affordable and efficient way for patients to exchange information with the doctor," said Jim Bodenbender, RelayHealth's senior vice president and general manager. "Payers and employers are recognizing that alternative levels of available care are important in helping to control costs, as well as to provide consumer convenience."

Success stories from Aetna and CIGNA may prove to be a tipping point in the market. "We believe the growth rate of online services for patients with their physicians will rapidly grow," said Bodenbender.

Even with the encouraging news from some payers, the AAFP will ask for an accounting from all of the country's major health plans as to how they will handle the 2008 CPT codes.

Letters from the AAFP will be sent to insurers, including Aetna, CIGNA, WellPoint, Humana and UnitedHealthcare, asking company executives for their official policies regarding payment for telephone and online physician services.

The Academy's policy on payment for non-face-to-face services states that physicians should be paid for services that are reasonable and necessary, safe and effective, and medically appropriate. "The technology used to deliver the services should not be a consideration," says the policy.

Ellington is optimistic about the future. "There is every expectation that as we move forward and health plans see the benefits of enhanced physician-patient communications, all health insurers will recognize and pay physicians for all of these codes," he said.