Making changes on the fly is never easy in any industry, especially healthcare – figuring out what platform to use, training staff and patients on how to operate video conferences, but more importantly, will you get paid? With the Corona Pandemic turning our revenue cycle upside-down due to the cancelling of most elective procedures, it’s more important than ever that we are accurately coding for all procedures, especially as we see a surge in Telehealth. Read our blog to learn more about the guidelines.
Center for Medicare & Medicaid Services (CMS) has broadened access to Medicare TeleHealth services so that beneficiaries can receive a wider range of services from their healthcare provider without traveling to a healthcare facility. Under the new 1135 wavier, Medicare can pay for office, hospital, and other visits furnished by a range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers starting March 6, 2020. Also, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for TeleHealth visits paid by federal healthcare programs.
Medicare beneficiaries can receive a specific set of services through TeleHealth including evaluation and management visits, mental health counseling and preventive health screenings. Medicare beneficiaries can be in any healthcare facility and in their homes.
There are three main types of virtual services healthcare professionals can provide: Medicare TeleHealth visits, virtual check-ins and e-visits.
Medicare TeleHealth Visits
- The provider must use an interactive audio and video telecommunications system that permits real-time communication between the patient the provider.
- The 1135 wavier requires that the patient have a prior established relationship with a healthcare provider, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.
- Document the encounter is a telemedicine visit via communication device (audio-video communication or audio/telephone only communication)
- Document the patient’s location and provider’s location
- Obtain and document patient’s verbal consent confirming that he/she agrees to be part of this telemedicine encounter. The visit is not billable without the patient’s documented consent
- Document the time spent in medical discussion: XX minutes (no time ranges)
- Document the encounter as you would any face-to-face encounter including history, exam (body systems that you see via screen), and medical decision making
- Established Medicare beneficiaries in their home may have a brief communication service with practitioners via several communication technologies including synchronous discussion over a telephone or exchange of information through video or image.
- These virtual check-ins are for patients with an established (or existing) relationship with a physician or certain practitioners where the communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available). The patient must verbally consent to receive virtual check-in services.
- In all types of locations including the patient’s home, and in all areas, established Medicare patients may have a non-face-to-face patient-initiated communications with their providers without going to the office by using online patient portals.
- The patient must generate the initial inquiry and communications can occur over a 7-day period
- 99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
- 99422 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
- 99423 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; over 20 minutes
- Clinicians who may not independently bill for evaluation and management visits (i.e., PT, OT, SLP, clinical psychologists) can provide these e-visits and bill the following codes:
- G2061 – Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
- G2062 – Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
- G2063 – Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; over 21 minutes
|TYPE OF SERVICE||WHAT IS THE SERVICE||HCPCS/CPT CODE|
|MEDICARE TELEHEALTH VISITS||A visit with a provider that uses telecommunication systems between a provider and a patient||
|VIRTUAL CHECK-IN||A brief (5-10 minutes) check in with your practitioner via telephone or other telecommunication device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient||
|E-VISITS||A communication between a patient and their provider through an online patient portal||
|TYPE OF VISIT||HCPCS/CPT CODE||DOCUMENTATION REQUIREMENTS|
|Telemedicine visits utilizing both audio & visual communication||
99201 – 99215
|Virtual check-in by telephone||G2012||
|Virtual review of images/videos by email or patient portal||G2010||
|E-visits by patient portal-MD, PA, NP||
99421 (5-10 min)
99422 (11-20 min)
99423 (21+ min)
|E-visits by patient portal – PT, OT, ST, Clinical psychologists||
G2061 (5-10 min)
G2062 (11-20 min)
G2063 (21+ min)
Quick links to helpful resources
Centers for Medicare & Medicaid Services (CMS) – https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
American Academy of Family Physicians (AAFP) – https://www.aafp.org/patient-care/emergency/2019-coronavirus/telehealth.html
American Psychiatric Association (APA) – https://www.psychiatry.org/psychiatrists/covid-19-coronavirus/practice-guidance-for-covid-19