Providing telemedicine sessions relative to COVID-19, and then billing for them, can be daunting.
Let’s break it down by looking at the different options available to you based on the services you provide.
Telephone and Online Digital Evaluation and Management Services
Four sets of CPT codes have been in existence for a while now; they’re billable based on certain guidelines for telephone calls or online digital evaluation.
99441 – 99443: Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided 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, 11-20 minutes and 21+ minutes.
What it really means: use this code set if you provide a telephone (not telemedicine) consult to an existing patient, parent, or guardian, and if that consult had nothing to do with another consult from within the past 7 days, and if the consult it won’t result in a service or procedure within the next 24 hours or soonest available appointment.
98966 – 98968: Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment 5-10 minutes, 11-20 minutes, 21+ minutes.
What it really means: it’s exactly the same as for the code set above, other than the consult was provided by a health care professional who’s not an MD, DO, DPM or DC.
99421 – 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days 5-10 minutes, 11-20 minutes and 21+ minutes
What it really means: Use this code set if you’ve had an online telemedicine session (not a phone call) with an existing patient for up to 7 days, and if sessions lasted 5-10, 11-20, and 21+ minutes.
98970 – 98972 (G2061 – G2063 for Medicare): Qualified non-physician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days 5-10 minutes, 11-20 minutes, 21+ minutes.
What it really means: it’s exactly the same as for the code set above, other than the online telemedicine session was provided by a health care professional who’s not an MD, DO, DPM or DC.
When and how can they be billed?
All of the following codes are billed with your office place of service and no modifier.
The following outlines different situations in which the codes can be billed. Keep the guidelines above in mind, and know that everything must be documented. These are examples only:
99441 – 99443: A physician or other qualified health care professional calls or receives a call from an established patient or their parent or guardian. The patient has not been seen within the last 7 days and the evaluation does not warrant an appointment within 24 hours or first available if no appointments are available within 24 hours.
What it really means: use this code set if a phone call was made or received by either party described, and they had a conversation. The patient hadn’t been seen in the past 7 days and no appointment needed to be made within 24 hours, or on first appointment availability.
98966 – 98968: A qualified non-physician health care professional calls or receives a call from an established patient or their parent or guardian. The patient has not been seen within the last 7 days and the evaluation does not warrant an appointment within 24 hours or first available if no appointments are available within 24 hours.
What it really means: exactly the same as described above, except the person on the medical side was a qualified non-physician.
99421 – 99423: A patient or their parent or guardian initiates communication through a HIPAA compliant method such as integrated patient portal or secure email. A physician or other qualified health care professional reviews and evaluates the request reviews medical records and may order additional requests or electronically prescribe medication. The 7 day cumulative time spent on the digital evaluation will be billed. The 7 day period begins when the physician or QHP personal review.
**note** if within the 7 day period a separately reported E/M visit occurs the provider’s time spent is incorporated into the E/M.
98970 – 98972 (G2061 – G2063 for Medicare) A patient or their parent or guardian initiates communication through a HIPAA compliant method such as integrated patient portal or secure email. A non-physician healthcare professional communicates with the patient during the encounter, she responds to the patient's health concerns, answers any medical questions, and recommends management. The non-physician healthcare professional documents the encounter in the patient's record. She may follow up via telephone to review any questions the patient may have or may follow up via email.
Now let’s talk about the newly deregulated Telemedicine.
Telemedicine involves a mobile app that lets physicians treat their patients remotely via video-chat with patients using a smart phone, tablet or computer that has a front-facing camera. Prior to COVID-19, there were many regulations that limited the scope of telemedicine.
One of those regulations was that the app used for video chat needed to be HIPAA compliant. While you’re able to use any video chat application in the COVID-19 crisis, we still highly recommend using a HIPAA compliant method if possible.
Telemedicine involves billing the typical E/M codes you would normally bill based on time and complexity. The differences are that the place of service type needs to be type 02 and modifier 95 would need to be appended to the charge.
MedicsRCM can default the modifier in the place of service code to make it easier!
95 - Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
Again, telemedicine is not simply a phone call or online review. It’s a “face to face” visit via video chat session.
It’s a little tricky, but the preceding explanations should provide some clarity. In any case, MedicsRCM is fully engaged in telemedicine billing and coding!
