In simple words: This code covers a doctor or other qualified healthcare professional's online discussions about your health problem and treatment plan, for established patients. It applies if they spend 21 minutes or more over a week, using email, secure messaging or similar methods.

This CPT code, 99423, represents an online digital evaluation and management (E/M) service provided to an established patient.It encompasses the physician's or qualified healthcare professional's cumulative time spent over a seven-day period, totaling 21 minutes or more.This includes initial inquiry review, patient data review, interaction with clinical staff, management plan development (including prescriptions or test orders), and subsequent digital communication.All professional decision-making within the same group practice contributes to the cumulative time.Permanent documentation is required.The service is not reported if a separate E/M visit occurs within seven days, if the inquiry is for the same or related problem within seven days of a previous E/M service, if related to a surgical procedure during the postoperative period, or if used concurrently with specific other codes (99091, 99374-99380, 99424-99427, 99437, 99487, 99489, 99491, 99495, 99496, and 93792-93793).

Example 1: An established patient with hypertension uses a secure patient portal to report elevated blood pressure readings. The physician reviews the readings, consults the patient's chart, determines the need for medication adjustment and communicates the changes via the portal, spending 25 minutes over a three-day period., An established diabetic patient communicates via secure email about inconsistent blood glucose levels despite medication adherence. The provider engages in a 30-minute email exchange over a week, reviewing lab results, adjusting medication and dietary recommendations, and scheduling a follow-up appointment., An established patient with chronic pain reports increased pain levels via a secure messaging app.Over 7 days, the physician spends 23 minutes reviewing medical records, speaking with the patient, and adjusting their pain medication regimen and physical therapy plan via secure messaging.

Detailed documentation is required, including the date and time of each communication, the nature of the patient's inquiry, the physician's assessment, the management plan implemented, and the method of communication.All communications should be stored securely and permanently (electronic or hard copy).

** The time spent by clinical staff is not included in the cumulative time for this code.This code should only be reported once per seven-day period, even if multiple communications occur during that time related to the same problem. This code is not reported if the online digital inquiry is for a new problem that is unrelated to the previous E/M service within the seven day period.