Telehealth coding tips

Following the start of the pandemic in March 2020, telehealth services have been a key way to keep money coming into the practice, making knowing how to accurately and appropriately code more important than ever.

Renee Slade, MD, FAAP, assistant professor of pediatrics at Rush University Medical College in Oak Park, Illinois, offered an overview for coding a variety of telehealth services at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition. She emphasized that all of the coding presented in her presentation was subject to change and to verify with up-to-date resources.

Although uptake of telehealth was slow prior to the pandemic, many studies have shown positive outcomes for its use including high satisfaction for both clinician and patient; overall convenience; a reduction in visits to the emergency department; and effective for the management of many chronic conditions.

Since the start of the pandemic, Slade noted that she had experiences that led to better care, reduction in exposure to infectious diseases, and the ability to educate parents of safety.

For the purposes of the presentation, telehealth referred to any visit that used communication technology in lieu of a face-to-face visit.

Telemedicine was used for any real-time synchronous video visit, which might also be called a virtual face-to-face visit. Telephone visits were any synchronous visits carried out via telephone. Digital visits were nonsynchronous and carried out through patient portals or secure email.

Current procedure terminology (CPT) codes for telemedicine visits have existed since 2017. Codes for telemedicine can be found in appendix P of the CPT manual. Commonly used codes for telemedicine include those used for office & outpatient evaluation and management (E/M) visits (99202-99215, 99417), subsequent hospital care (99231-99233), inpatient consultation (99251-99255), outpatient consultation (99241-99245), and others.

The modifier 95 should be added to all codes used for telemedicine service. The place of service code should be 02, unless a payer prefers using the site of the clinician, where 11 for office or 22 for outpatient hospital facility would be used. Slade stressed that knowing and understanding payers’ policies would prevent future coding headaches.

Telephone visits can be used for established relationships. Practices should create an outgoing message that sets patient expectations about who will be calling back and when a return call may occur. They must be started by the patient and can only be used for a visit with a health problem. Clinicians should document the length of the call as that is the only determinant of the correct code.

Codes for telephone visits can only be submitted by a physician or qualified health professional. The visit cannot be from an E/M service in the past 7 days or leading to an E/M service in the next 24 hours or next available appointment. If this is the case, the time of the telephone call should be combined with the face-to-face visit time, when submitting according to time. The CPT codes are 99441 (visit of 5-10 minutes duration), 99442 (visit of 11-20 minutes duration), and 99443 (visit of 21-30 minutes duration).

Digital visits are only for established visits and the service is cumulative over 7 days, with the clock starting when the physician reviews the patient inquiry. Only time spent on the visit by a physician or qualified health professional can be counted. The visit can’t be reported if less than 5 minutes is spent on it, occurs during the global period of a procedure, or is E/M linked to the same problem with 7 days of a telemedicine or face-to-face visit, although the time can be added in, if billing is based on time.

An unrelated incident in that 7 day window can be reported as a separate visit. Clinicians should follow payer guidance on coding, with some requiring the XU modifier. Codes are 99421 (digital visit with cumulative 5-10 minutes), 99422 (digital visit with cumulative 11- 20 minutes), and 99423 (digital visit with cumulative 22+ minutes).

This article was originally published on Contemporary Pediatrics®.

Reference

1. Slade R. Coding for virtual, digital, and telehealth services. American Academy of Pediatrics 2021 National Conference & Exhibition; virtual. Accessed October 9, 2021.