[Ohioaap-practicemanagers] Cleveland Clinic Billing for Increasing Amount of Time on Medical Decision Making

[Kristen Fluitt]

"Here's an important development.
Media are reporting that the Cleveland Clinic and soon Cleveland's University Hospital system is or will be billing for the increasing amount of time spent on medical decision making conducted through patient portals, texts, and emails. https://dispatch-oh.newsmemory.com/?publink=1da6e82f2_13486e2

The Cleveland Clinic is following the maxim: if what you’re currently doing without payment has value (and is taking more and more of your time these days),  the way to eventually change payer policy is to start billing a reasonable amount for these services and advise patients that there is a charge for them.  You can use the billing data you assemble to make your case to the payers about the frequency with which you do this work that keeps patients from more expensive visits into the office or ED.

 There are CPT codes 99421, 2, and 3 for “Online Digital E/M services” such as via patient portal or secure text or secure email for encounters taking more than 5 minutes of provider time, initiated by an established family, cumulative over the course of a week, so long as it’s not within 7 days of a past visit about that problem or doesn’t result in a visit within 24 hours or in a “first available” in person visit.

 “Provider time” includes reviewing  the online request and pertinent records, developing a plan or prescriptions or ordering tests, documenting in the record (a requirement), and communicating back to the family.

 In 2022, the physician work RVUs for those CPT codes,  applied to the Medicare conversion factors, equated to $15.22 for 5-10 minutes of work, $29.76 for 11-20 minutes, and $48.45 for 21 or more minutes.

Jonathan Price MD FAAP
Co-chair, Pediatric Care Council, Ohio Chapter AAP"

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