CPT® code 99422 is used to report an online digital evaluation and management (E/M) service for an established patient, typically provided via secure patient portal or other HIPAA-compliant digital communication. This code applies when a physician or qualified healthcare professional provides moderate-complexity assessment and management without an in-person visit, using digital means to address patient concerns.
When to Use CPT® Code 99422
- When providing digital E/M services for an established patient that require moderate complexity medical decision-making.
- For conditions that can be evaluated and managed electronically, such as medication adjustments, follow-up questions, or chronic disease management.
- When at least 11 minutes of cumulative provider time is spent over a 7-day period in connection with the patient’s digital communication.
- Communication must be secure and HIPAA-compliant.
Billing Requirements
- Document the time spent, medical decision-making, and patient communications.
- Report once per 7-day period; multiple messages or interactions within that timeframe are aggregated.
- Ensure the service is not related to a visit in-person or via telehealth that occurs within the same week.
- Follow payer-specific rules for coverage and reimbursement of digital E/M services.
Common Clinical Scenarios
- A patient messages their provider about a medication side effect, and the provider evaluates and adjusts therapy electronically.
- A provider reviews lab results submitted digitally and communicates management instructions through a secure portal.
- A patient with a chronic condition receives guidance and care coordination digitally without needing an office visit.
Simplify Digital E/M Services with OptiMantra
Billing for CPT® 99422 requires precise documentation of digital communication and medical decision-making. OptiMantra’s EMR and practice management platform makes it easy to log online interactions, track cumulative provider time, and generate clean claims. Practices can offer virtual care efficiently while ensuring compliance and accurate reimbursement, allowing providers to focus on delivering high-quality patient care.
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