Knowing how to correctly code, bill and get paid for remote services (telemedicine) might be the only way your practice can continue to provide services to your patients without risking the spread of COVID-19.
Telehealth services reimbursement has become an overnight necessity for many practices with the recent highly-infectious coronavirus outbreak. The challenge is that they come with major requirements you must comply with.
If not, payers are promising to come down hard on violations with targeted audits this summer.
There are a variety of ways you can protect the health of your patients, staff, and providers, and get paid for non-face-to-face service. The expert advice below offers a few of the ways you can code, document and bill for telemedicine services.
IMPORTANT: The expert advice below is an overview of five ways you can see more patients remotely, hold off the spread of this hyper-infectious virus and get paid for the remote services you provide. To receive additional telemedicine options, and get more detailed information on coding, billing and getting paid for them, be sure to register the this upcoming online training “Coronavirus: Get Paid to Manage Patients Remotely.”
Restrict Telehealth (99201-99215) to Video Inclusion
CMS restricts telehealth to services (99201-99215, Office visit codes) that include two-way video. Both the patient and the doctor must be able to see each other.
Be sure to save the video documentation, warns Terry Fletcher, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA. Medicare, trailblazer, and other insurers have already lined up auditors to review claims for this requirement after things get back to normal.
Starting in July 2020, insurer have made it clear that they’ll demand repayments and their associated financial penalties associated with telehealth rule violations. This includes all paid telehealth services that fail to have associated stored video recordings.
Getting Paid for Video-Free Care
If your remote patient care doesn’t record video (for instance your provider is talking to the patient over a traditional phone call), you still can provide, and be reimbursed, for SOME of the non-face-to-face services you provide. Nationally-recognized coding and training expert, Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC, tells you how below:
Report Telephone Calls Using G2012
Although there are specific CPT codes for phone-call care (99441-99443), most payers do not reimburse for them. However, code G2012 (Digital communication service) does not require the video link and is reimbursable by a variety of payers.
- Digital Communication (G2012) definition – Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, 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; 5-10 minutes of medical discussion
Should your non-video care claims get targeted for review, auditors will look for the following items to support G2012:
- Established patient: G2012 has been in effect since 1/1/2019 – it is supposed to be for an established patient, but CMS has said they will not audit for that requirement during this time.
- Physician, Nonphysician practitioner service: If a registered nurse, medical assistant, or other axillary staff provides the patient call, do not use G2012. Only physicians, nurse practitioners, physician assistants and other qualified health care professionals who bill mid- and high-level office visit codes (eg 99212-99215) are allowed to bill the digital communications codes.
- Unrelated office visit: The call cannot be related to an office visit within the past 7 days, as that would be considered part of the work of the already-billed office visit.
- Example: If a provider-patient call prompts the doctor to advise the patient to come in at the first available appointment, you should not bill G2012. The call would be considered the pre-work for the upcoming office visit.
- Minutes, Need, Consent Documentation: The following three items must be documented in the patient’s medical record:
- Time: G2012 specifies 5-10 minutes of medical discussion. Therefore, documentation should indicate the call’s total time or start and stop times.
- Medical necessity: There are no service-specific documentation requirements for G2012, but documentation must show medical necessity.
- Verbal consent: The provider must attain the patient’s verbal agreement to have the service performed remotely and be billed for it.
Get Paid for Remote Image Evaluations
Your providers can receive reimbursement for the medically necessary review of a patient-provided picture of the chest area or an affected eye if they accurately utilize G2010 (remote imaging evaluations).
- Digital Image Evaluation (G2010) definition – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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
Requirements: Code G2012 has similar requirements as G2012 except no time documentation is needed. Use G2012 only when the service passes these restrictions:
- Performed for an established patient
- Provided by a physician or nonphysician practitioner
- Is not related to an office visit in the past 7 days or an appointment in the next 24 hours
- Includes documentation indicating medical necessity and the patient’s verbal consent
Apply New 2020 CPT Codes for Patient Portal Service
For email or portal communication, CPT 2020 introduced the following new digital evaluation codes:
- 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 – …11-20 minutes
- 99423 – … 21 or more minutes
These codes have restrictions similar to the digital communication G codes. When a provider communicates with a patient via your portal or secure email, bill the applicable 9942x code provided the service meets three requirements:
- The patient-initiated digital communications required a clinical decision that would otherwise be made during an office visit
- The time includes only physician/qualified healthcare professional (QHP)
- The patient has not been seen in person or through telehealth within the 7-day period.
Master Remove Services with More Training
