How to code for online consultations
By Marty Kotlar, DC, CHCC

I have been communicating with my patients online for the last six months. I give them spinal-care recommendations, exercise instructions, and other types of healthcare advice. Can I charge patients for this service? Do any insurance companies reimburse for communicating with patients online? If so, is there a CPT code to use?

The answers to your questions are “Yes, Yes, and Yes.” On January 1, 2004, the American Medical Association, keepers of the CPT codes, issued CPT code 0074T, described as “an online Evaluation and Management (E&M) 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 code 0074T is considered a Category III CPT code, which is used to identify temporary codes for emerging technologies, services, and procedures.

This is good news for DCs who provide online chiropractic healthcare information to their patients and want to get reimbursed for their time.

The existence of this code does not necessarily imply that all health insurance carriers will immediately accept it. Several insurance companies, including Well Point, Blue Shield of California, Empire Blue Cross, GHI, BCBS Massachusetts, BCBS Florida, and BCBS of Kansas City, now reimburse providers for online consultations.

Ask your insurance CAs to check with individual insurance companies to determine if online consultations will be a covered service. If a particular health plan does not cover this service, I think most patients would be willing to pay to get answers to their clinical questions answered online, rather than be forced to make an office visit.

Research indicates that about one-third of doctor visits involve situations that could have been handled without face-to-face time between the doctor and patient. Handling the issues online could actually result in better quality healthcare advice. Most patients remember less than half of what they’re told during an in-person office visit, and much of what they do recall is incorrect.

Advice sent by e-mail gives the patient a written record of the recommendation, which could be easily shared with family and friends.

For example: Remember when Merck announced a voluntary withdrawal of Vioxx from the U.S. and worldwide markets, due to safety concerns of an increased risk of cardiovascular events? With billing for online consultation, DCs who answered individual e-mails asking for advice could bill for their time.

Marty Kotlar, DC, CHCC, is the president of Target Coding (www.TargetCoding.com). Target Coding, in conjunction with Foot Levelers, Inc., is offering continuing-education seminars on CPT coding and documentation. He can be reached at 800-270-7044, through his Web site, or by e-mail at drkotlar@targetcoding.com