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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| Get Paid More for Your Virtual Care Services |
CPT Code 99211: Get $15 Per Patient on Nonphysician Work | Get Paid $23/ea. for New Patient COVID-19 Testing With 99211 | ||||||||
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