Medical Billing ServicesMedical Coding

2020 Medical Coding Update for Telehealth

There are three options for telehealth and other communications-based technology services i.e. Telephone calls, Internet consultations, and Telemedicine exams. This information is based on guidelines from the Centers for Medicare & Medicaid Services.

1. Telephone Calls

HCPCS code G2012 Description: 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 seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

  • 2020 wRVU: 0.25
  • National non-facility payment: $14.80
  • National facility payment: $13.35

Code

Value

Description

HCPCS code G2012 $14.81 Medicare Part B 5-10 minutes of medical discussion
Coverage varies per commercial plan

Documentation Requirements for HCPCS code G2012

  • Confirm patient identity (e.g., name, date of birth or other identifying information as needed, in particular, if documenting independently from the patient’s electronic or paper record).
  • Confirm that the patient is an established patient to the practice.
  • Detail what occurred during the communication (e.g., patient problem(s), details of the encounter as warranted) to establish medical necessity.
  • Document the total amount of time spent in communicating with the patient and only submit code G2012 if a minimum of five minutes of direct communication with the patient was achieved.
  • The document that the nature of the call was not tied to a face-to-face office visit or procedure that occurred within the past seven days.
  • The document that a subsequent office visit for the patient’s problems was not indicated within 24 hours or the next available appointment.
  • Include that the patient provided consent for the service.

Service Provider: MDs, DOs, ODs

HCPCS code 99441 Description: Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian 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. Non-covered Medicare services, coverage varies per commercial plan.

Code
Description
99441 5-10 minutes of medical discussion
99442 11-20 minutes of medical discussion
99443 21-30 minutes of medical discussion

Service Provider: Physician Assistants or Nurse Practitioners

HCPCS code 98966 Description: Telephone assessment and management service provided by a qualified non-physician, health care professional to an established patient, parent, or management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment. Non-covered Medicare services, coverage varies per commercial plan.

Code
Description
98966 5-10 minutes of medical discussion
98967 11-20 minutes of medical discussion
98968 21-30 minutes of medical discussion
  • Initiated by established patients
  • If the telephone service ends with a decision to see the patient within 24 hours or the next available urgent visit appointment, the code is not reported. The encounter is considered part of the preservice work of the subsequent assessment and management service, procedure and visit.
  • If the call refers to a service performed and reported within the previous seven days or within the post-operative period of the previously completed procedure, then the service is considered part of the previous service or procedure.

2. Internet Consultations

  1. Initiated by established patients
  2. Covers seven days
  3. Not to be used for:
    • Scheduling appointments
    • Conveying test results
  4. Must be through HIPAA compliant secure platforms such as:
    • Electronic health record portals
    • Secure email, etc.

Service Provider: Physicians

HCPCS code 99421 Description: Online digital E/M service, for an established patient, for up to seven days, the cumulative time during the seven days.

Code

Value

Description

99421  $    15.52 5-10 min
99422  $    31.04 11-20 minutes
99423  $    50.16 21 or more minutes

Service Provider: (Non-Physicians) Physician Assistants and Nurse Practitioners

HCPCS code 98970 Description: Online digital E/M service, for an established patient, for up to seven days, the cumulative time during the seven days. Non-covered Medicare services, coverage varies per commercial plan.

Code

Description

98970 5-10 min
98971 11-20 minutes
98972 21 or more minutes

3. Telemedicine Exams

Telemedicine is defined by a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician.

  • The examination and communication of information exchange between the physician and the patient must be the same as when rendered face-to-face.
  • Code-level selection is based on the same criteria for the base codes.
  • Telemedicine codes are identified by an asterisk (*) in CPT book
    • Office-based
  • 99201 – 99205 E/M new patient
  • 99212 – 99215 E/M established patient
  • Does not apply to tech code 99211 or Eye visit codes

Office consultations

  • For insurance that still recognizes this family of codes: 99241 – 99245
  • Subsequent Hospital Care: 99231 – 99233
  • Inpatient Consultation: 99251 – 99255
  • Subsequent Nursing Facility Care: 99307-99310
  • Append modifier -95 Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications systems.
  • List the place of service as 2.

In case of any assistance needed for telehealth medical billing and coding, you can contact Medical Billers and Coders (MBC) at 888-357-3226/ info@medicalbillersandcoders.com

Reference:

Coding for Phone Calls, Internet and Telehealth Consultations

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