Two responses above commented that if the patient was sent to the ER based on the email communication, that they were not charged. Another commented that we couldn't charge for multiple back and forth messages. Why not? Because the problem wasn't solved by the email?
This is exactly why we are in this death spiral of decreasing payments, because we don't recognize that our time, advice and experience are valuable, and we should be paid for it. Let's not begin providing a new service for which we are underpaid!