CPT® Code 98970

1. Indications

The CPT® Code 98970 is indicated for use when an established patient requires online digital assessment and management services provided by a nonphysician qualified health care professional. The specific indications for this service include:

• Established Patient: The patient must be an established individual who has previously received care from the health care professional.
• Digital Communication Initiation: The service is initiated by the patient through electronic means such as email or an EHR portal.
• Nonphysician Qualified Health Care Professional: The assessment and management must be conducted by a qualified nonphysician professional, such as a registered dietician, physical therapist, occupational therapist, or speech-language pathologist.
• New Inquiry: The digital encounter must begin with a review of a new inquiry from the patient that is unrelated to any postoperative or previous assessment and management service within the last seven days.

2. Procedure

The procedure for CPT® Code 98970 involves several key steps that outline the process of providing online digital assessment and management services:

• Step 1: Patient Initiation The process begins when an established patient initiates contact through an electronic communication method, such as email or an EHR portal, presenting their concerns or inquiries.
• Step 2: Review of Inquiry The nonphysician qualified health care professional reviews the patient's initial inquiry, which includes understanding the complaints and concerns raised by the patient.
• Step 3: Data Review The professional examines the patient's medical records and any other pertinent data that may assist in understanding the patient's current health status and needs.
• Step 4: Information Gathering Additional related information may be requested from the patient to clarify their concerns and ensure a comprehensive understanding of the issue at hand.
• Step 5: Collaboration The qualified professional may collaborate with clinical staff regarding the patient's problem to ensure a well-rounded approach to the management of the patient's health issue.
• Step 6: Management Plan Development Based on the information gathered, the professional develops a management or treatment plan tailored to the patient's needs.
• Step 7: Prescriptions and Orders If necessary, the professional may write prescriptions or order tests to further address the patient's health concerns.
• Step 8: Counseling and Instruction The professional provides patient counseling and instruction as needed, ensuring that the patient understands the management plan and any next steps.
• Step 9: Documentation All aspects of the digital encounter, including communications and decisions made, must be documented and stored in the patient's medical record for future reference.

3. Post-Procedure

After the completion of the online digital assessment and management service, the patient may expect to receive follow-up communication regarding their management plan. The qualified health care professional may provide additional instructions or recommendations based on the outcomes of the digital encounter. It is essential for the patient to adhere to the management plan and any prescribed treatments or tests. The documentation of the encounter will be stored in the medical record, which can be referenced in future visits or communications. The cumulative time spent on the digital service is reported, and if further assessment is needed, the patient may initiate another digital encounter within the appropriate time frame.