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Telehealth codes to know

Medical Economics JournalJune 2020 Edition
Volume 97
Issue 10

There are numerous coding options when it comes to reporting telehealth visits and others that are not the traditional face-to-face office visit.

There are numerous options when it comes to reporting visits that are not the traditional face-to-face office visit. This varies somewhat by payer, of course.

Medicare has temporarily relaxed some of the geographic and security/privacy restrictions on Telehealth visits – including the office visit codes. This will allow patients to call your office, and as long as there is some type of combined audio/video communication between the provider and the patient – these ‘visits’ can be billed with the 99201-99215 series codes, adding the 95 modifier.

For Medicare there are numerous options:

Office Codes (99201-99215)

The new visit codes to the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency

Any new visit codes 99201-99205 would likely need to be coded based on time given the limitations of the exam. The established patient codes 99211-99215 could be billed by counseling time or by documenting the level of history and medical decision-making associated with a given code level.

Virtual Check-Ins (G2012)

A brief (5-10 minutes) check in with your practitioner via telephone or other telecommunications devise to decide whether an office visit or other service is needed. This is provided to an established patient, 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

E-Visits (G2061-G2063)

Online digital E/M service, for an established patient, for up to 7 days, cumulative time during the 7 days. For Medicare these are:

  • G2061: for up to 7 days, cumulative time during the 7 days; 5-10 mins.
  • G2062: for up to 7 days, cumulative time during the 7 days; 11-20 mins.
  • G2063: for up to seven days, cumulative time during the 7 days; 21 or more minutes.

Private payers

For private payers and some Medicare Replacement plans, you can use:

  1. 99421: 5-10 minutes
  2. 99422: 11-20 minutes
  3. 99423: 21 or more minutes

Those are the mainstream codes to consider here. Reimbursement varies with the office visit codes typically paying the most. Go the websites for United Healthcare, BCBS, Aetna, CIGNA, Humana and others for specific policy changes.

To document your visit, be sure to note in your EHR the date, time and duration of the encounter. Also record the relevant history, and exam, decision-making and other management elements as you would any other visit.

Bill Dacey, MHA,MBA, CPC, is principal in The Dacey Group, Inc., a consulting firm dedicated to coding, billing, documentation, and compliance concerns for physicians. Dacey is a AAPC-certified coding instructor and has been active in physician training for more than 25 years. He can be reached at billdacey@msn.com.

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