Clinical Examples of E-Visits by Audiologists and SLPs

The following clinical scenarios provide examples describing e-visit services by audiologists and SLPs. E-visit services are reported using Current Procedural Terminology (CPT ® American Medical Association) codes 98970-98972. These scenarios should be considered for illustrative purposes only. Always check with your payers regarding coverage and payment before billing for e-visits or other communication technology-based services, such as virtual check-ins. Contact ASHA at reimbursement@asha.org for additional information.

Audiology Examples

Patient with Cochlear Implant (CI)

A patient recently received a cochlear implant (CI)—a surgically implanted device to help with severe hearing loss. The physician refers the patient to an audiologist for CI analysis and programming (CPT codes 92601-92604). The audiologist has been seeing the patient to activate the external sound processor post-surgery, and to perform the diagnostic analysis and programming of the implant. Initial programming typically occurs over a series of visits and is individualized to each patient based on the results of the diagnostic analysis of auditory perception. Additional programming may also be necessary to adjust the sound processor to accommodate improvements or decline in the patient’s ability to hear and understand speech.

The patient contacts the audiologist through the patient portal after the initial programming to report that she is not hearing well with the CI. After finishing clinical care for the day, the audiologist reviews the message received through the portal and responds with a series of questions to assess if it may be a malfunction with the CI equipment, a change in health status that may require medical attention, or a need for the audiologist to adjust the programming of the CI. The patient answers the initial questions and a few follow-up questions through the portal. Based on the patient’s description of the problem and examples of specific situations in which hearing is most challenging and any precipitating events, the audiologist determines that the hearing difficulties are likely due to equipment malfunction and recommends the patient contact the CI manufacturer’s consumer line directly to troubleshoot the CI processor for possible repair or replacement. The audiologist saves the clinical documentation of the assessment to the medical record and forwards a copy to the referring physician through the portal.

This scenario illustrates a shorter interaction that could be reported with CPT code 98970 (5–10 minutes cumulative).

However, if the initial exchange points to issues unrelated to equipment malfunction, the audiologist proceeds to ask additional questions to assess whether this is a potential change in health status or a need for further analysis and programming of the CI. This also involves reviewing relevant medical history such as recent head trauma or injury to the site over the implant, illness, hormonal changes, and/or medications. This can lead to a consult with the referring physician that results in the patient’s follow-up office visit with the physician, a recommendation for additional CI programming with the audiologist, or a discussion of strategies the patient can implement before returning for a regularly scheduled follow-up appointment for diagnostic analysis and programming. The audiologist saves the clinical documentation of the assessment to the medical record and forwards a copy to the referring physician through the portal.

This scenario illustrates a lengthier interaction that could be reported with CPT code 98971 (11–20 minutes, cumulative) or 98972 (21 minutes or more, cumulative), depending on the patient’s ability to describe symptoms and the level of follow-up probing required.

Patient with Tinnitus

A patient has previously been evaluated by the physician and audiologist with a diagnosis of tinnitus. This includes the audiologist’s diagnostic testing of tinnitus severity, current level of tinnitus handicap, and impact on daily function (CPT code 92625). The testing may also include a brief depression screening. The physician has reviewed the results of the audiologic testing and discussed treatment options with the patient.

The established patient contacts the audiologist through the patient portal four months later, reporting a sudden increase in tinnitus loudness, severity, and impact on concentration and sleep. The audiologist responds with a series of questions about health and medication changes and administers standardized questionnaires such as a tinnitus handicap inventory (THI) and/or tinnitus function inventory (TFI) via the portal to assess the amount of tinnitus the patient is currently experiencing. The patient answers the initial questions and completes and returns the questionnaires. The audiologist compares current results to initial measures. Based on the patient’s description of the problem and amount of tinnitus change and medical history, the audiologist determines that the patient needs a referral to an otolaryngologist. The audiologist saves the clinical documentation of the assessment to the medical record and forwards a copy to the referring physician through the secure patient portal.

This scenario illustrates a shorter interaction that could be reported with CPT code 98970 (5–10 minutes cumulative).

However, if the initial exchange points to potentially complicated personal, emotional, or psychosocial issues being involved, the audiologist will proceed to ask additional questions to assess the patient’s depression level and risk of harm to self and others. If the patient is reporting severe—but not emergent—changes the audiologist consults with the referring physician, which may lead to referring the patient to an appropriate physician or behavioral health professional for intervention. If emergent needs are identified, the audiologist, as a mandatory reporter, is required to proceed with additional referrals (such as psychiatry, psychology, and/or primary care) and recommendations to ensure the safety of the patient. The audiologist saves the clinical documentation of the assessment to the medical record and forwards a copy to the referring physician through the secure patient portal.

Speech-Language Pathology Examples

Patient with Swallowing Difficulties

A patient has been seeing an SLP for treatment of swallowing difficulties following a stroke. The patient is already under the care of a physician. Treatment of swallowing dysfunction may include training on how to use muscles for chewing and swallowing, identifying ways to position the head and body when eating, teaching strategies to help swallow better and safer, and making recommendations regarding food texture and consistency to make swallowing easier for the patient. Families and caregivers often actively engage in strategies to ensure the patient is swallowing safely and effectively at home by helping with exercises, making food and drinks the patient can swallow safely, and keeping track of how much the patient is eating and drinking.

A few weeks after initial therapy, the patient and/or family contacts the SLP through the patient portal, noting that they are having trouble implementing the exercises and safe swallowing strategies that the SLP worked on with the patient in treatment. After finishing therapy for the day, the SLP reviews messages that have come in through the patient portal. The SLP responds to the message with follow-up questions regarding the patient’s response to exercises and probes for more information regarding specific situations or foods the patient may be having trouble with. After response from the patient and/or family the next day, the SLP provides some strategies to address the functional impairment and sends links to online videos that demonstrate those strategies in practice. The SLP saves the clinical documentation of the assessment to the medical record and forwards a copy to the referring physician.

This scenario illustrates a shorter interaction that could be reported with CPT code 98970 (5–10 minutes cumulative).

After a few more sessions of face-to-face therapy, the SLP instructs the family to closely monitor how much food and how many calories the patient consumes over a two-week period and what types and textures of foods the patient can tolerate. After two weeks of monitoring, the family uses the secure patient portal to report this information to the SLP, who assesses the patient’s progress and asks probing questions. Based on the assessment, the SLP consults with the referring physician regarding concerns with changes in health status, which could lead to a recommending the patient schedule an appointment with their physician, return to the clinic for additional therapy with the SLP, or implement additional at-home safe swallowing strategies and exercises before returning for a regularly scheduled treatment session. The SLP saves the clinical documentation of the assessment to the medical record and forwards a copy to the referring physician through the secure patient portal.

This scenario illustrates a lengthier interaction that could be reported with CPT code 98971 (11–20 minutes, cumulative) or 98972 (21 minutes or more, cumulative), depending on the family’s ability to track and describe symptoms and progress, and the level of follow-up probing required.