This is pre-release documentation and is subject to change.
Non-Direct Care is Evaluation and Management Care that is provided to patients who are not present in the office and who are not seen using a video component like in Telehealth or Telemedicine. In OP, these episodes of care are documented in Message(s). To reduce the burden of combing through the entire Message Center, reviewing the patient visit information in their chart, and manually creating claims for Messages that meet the Non-Direct Care billing guidelines, practice staff can utilize the Non-Direct Care Billing Center.
The Non-Direct Care Billing Center centralizes the review of messages, the review of encounters in the global period, and the creation of charges. Messages that contain information in one or both of the following fields are automatically displayed in the Non-Direct Care Billing Center:
- The DX 1 and/or DX 2 field must be populated
- The Time Spent field must be populated
While Messages will be included in the Non-Direct Care Billing Center with only one of these fields completed, we recommend populating both the Diagnosis and Time Spent fields for the most seamless workflow.
"If the Provider enters the diagnosis in the body of the message, will the message be displayed in the Non-Direct Care Billing Center?"
A message entered in this way will only be displayed in the Non-Direct Care Billing Center if the Time Spent field is populated.
Billing Non-Direct Care
The presence of a documented Diagnosis Code or Time Spent does not necessarily mean that it is appropriate to bill the episode of care. The appropriateness of billing for Non-Direct Care depends on many factors including what other care was provided to the patient within the global period. Determining whether or not Non-Direct Messages are billable is solely the responsibility of the Practice. Below is a summary of each Global Period. Further information, provided by the AAP, can be found here.
Care Provided via Telephone
So that all potential encounters within the global period are presented in the Telephone Worklist, encounters will be included from 7 days prior to the message to 3 days after it. The 3 day post-Message period accommodates practices that do not offer weekend appointments.
Non-Direct Care provided by Providers via Telephone Messages is billed with the following CPT Codes based on CMS:
- 99441: Telephone evaluation and management to a patient, parent or guardian not originating from a related E/M service within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
- 99442: 11-20 minutes of medical discussion
- 99443: 21-30 minutes of medical discussion
Care Provided Online (Portal) Messages
So that all potential encounters within the global period are presented in the Portal Worklist, encounters will be included until 7 days after the message.
Non-Direct Care provided by Providers via Online (Portal) Messages is billed with the following CPT Codes based on CMS:
- 999421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
- 99422: 11-20 minutes
- 99423: 21 or more minutes