QUESTION: Our patients really love the convenience and safety of telehealth, and we are planning to continue offering the services long-term. Can you provide us with some clarification on how to use CPT code 99441-99443 vs 99201-99215 when the video exam is not straightforward? Some example include: What if there are technical issues and the encounter ends up being completed with audio only (no video)? What if the patient requests a third party be included in the encounter, such as a relay or interpreter?

Question from Rochester, New York subscriber

ANSWER: You can still bill Medicare (and some private payers) for phone and special service encounters as telehealth, but your CPT code sets selection depends on the audio component. Here’s what to look for to accurately report telehealth exams and evaluations based on the audio:

Primarily Audio-Visual: If the service mainly used audio-visual and the components for telehealth exam codes 99201-99215 were performed and documented, then you should use the evaluation and management codes appended with the telehealth modifier 95 (Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system) and the Place of Service code where the service normally would occur (such as the Office billed with Place of Service Code 02).
Mainly Audio: However, when the video disconnection or relay service means the components were not met by video, then you instead should use the telephone call codes (such as CPT code 99441 for the telehealth service). You should append modifier 95 since CMS classifies telephone codes as telehealth under the Public Health Emergency for the COVID-19 pandemic.

Apply the same technical component criteria to all extended communication services. CMS indicates, “If a practitioner receives TTY, relay services, accessible software, interpreter services support, or other means of effective communication, then they would use the same billing codes for when they don’t need TTY, relay services, accessible software interpreter services, or other means of effective communication.” Remember that you cannot charge patients more for a telehealth visits if the patient requires TTY relay services, accessible software, interpreter services or other means of effective communication.

When selecting your codes, it’s important that you check who provided the service or you could end up committing billing fraud. Both physicians and nonphysician practitioners may bill codes 99201-99215 and 99441-99443. If a qualified healthcare provider provides the phone assessment, you should report telephone call codes 98966-98968.

Regardless of whether your provider’s service meets the requirements for a telephone or office evaluation, you’ll receive about the same payment. During the pandemic, CMS has valued 99441-99443 the same as 99213-99215, meaning 99441 pays the same as 99213.

Source: June 19 COVID-19 FAQs on Medicare Fee-for-Service Billing

Emergency changes: There is so much more to know about telemedicine. CMS telehealth rules continue to evolve. The only way to help your staff and your practice by using the applicable codes is to have a firm handle on the requirements.

That’s where nationally recognized coding expert and educator, Leonta Williams, MBA, RHIA, CCS, CCDS, CPC, CPCO, CEMC, CHONC, CRC, can help. In Gain $50 for E-Visits, July 2020 CMS Rule Notice, she’ll give you step-by-step advice on how to successfully bill for these claims and reap the financial reward for your telemedicine services