Telehealth Plus Specimen Collection: Prevent Revenue Loss

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Telehealth Plus Specimen Collection: Prevent Revenue Loss

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CPT code 99211 specimen collection

QUESTION: Our doctor performed a telehealth exam that resulted in the patient coming into the office later that day for an in-person COVID-19 test. Can we bill CPT code 99211 for the specimen collection AND 99203 for the telehealth encounter when they occur on the same day? If so, should modifier 25 be added to 99211?  

Question from Louisville, KY subscriber

ANSWER: No, you cannot report CPT code 99211 for the specimen collection in addition to the telehealth service code (e.g., 99203) when they occur on the same day. CPT considers the work of collecting a specimen as part of the same day’s related E/M service. In addition, most insurers billing guidelines allow reimbursement from the same provider for only one E/M service per day. Reporting both services would be considered unbundling and the insurer may cover only the lesser charge.

Think of it another way. A patient comes into your office for a visit that results in the provider admitting the patient to the hospital and the provider visits the patient in the hospital that evening. You would roll both E/M services into one code and select the hospital admission code that includes the total day’s history, exam, and medical decision making.

Do the same thing when billing a same-day telehealth service and specimen collection. Determine the E/M code based on the work the provider performed and documented for both services.

IMPORTANT: CMS now allows CPT code 99211 for specimen collection of both new and existing patients. For more on getting $23 extra for billing these services, sign up for the online training “Get Paid $23/ea. for New Patient COVID-19 Testing With 99211” from coding and billing expert, Brenda Edwards, CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC, CRCS, CMCS.


Online Training to Boost CPT Code 99211 Revenue

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Meet Your Writer

Jen Godreau CPC, CPMA, CPEDC, COPC Content Director

Jennifer Godreau, CPC, CPMA, CPEDC, COPC, has almost 20 years of experience in billing, coding, compliance, and practice management. She develops the content and programs for Healthcare Training Leader, a practice-specific online training company offering step-by-step advice on increasing reimbursement and avoiding compliance violations. Prior to joining Healthcare Training Leader, Jennifer supervised the program delivery for EMRs, practice management systems and compliance and revenue cycle services for more than 6,000 providers. Thousands of software products - encoders, claims management, auditing, and HIPAA compliance, have been created with her teams and helped thousands of practices more easily reduce revenue losses and comply with complex regulations. Her passion for breaking down healthcare rules and requirements in simple steps has provided practical advice, education, and risk reduction strategies to numerous associations, payers and medical specialties especially in primary care, otolaryngology, eye care, and pediatrics. Jennifer’s advocacy resulted in supervision rule revisions, new CPT codes, and CMS compliance contracts. She oversaw the provider auditing and education for one of the major corporate integrity health system settlements. Jennifer has authored and presented on numerous healthcare compliance and payment challenges. Her education guides include the Certified Otolaryngology Coder (CENTC) exam study guide and the AAPC Professional Medical Coding Curriculum. Jennifer has a Bachelor of Arts from Wittenberg University in Springfield, Ohio. She holds certificates in coding, auditing, pediatric coding, and ophthalmology billing and coding, and is AAPC Vice President of the Naples, FL chapter. Please reach out to Jennifer for step-by-step guidance at editorial@hctrainingleader.com