Introduction to Telehealth Coding

Clinical Issues and Solutions/Documentation Guidance

Susanne Talebian, CUA, CPC-I, CPC


Urol Nurs. 2020;40(4):195-200. 

In This Article

Abstract and Introduction


On March 24, 2020, the Centers for Medicare & Medicaid Services (CMS) stated the use of telehealth is vital to combat COVID-19. This was after the Secretary of the U.S. Department of Health and Human Services (DHHS), in response to COVID-19, declared a public health emergency on January 31, 2020, under section 319 of the Public Health Service Act (42 U.S.C. 247d). This was done in an overall effort to minimize the risk of exposure and community spread, and increase access to care. The CMS and DHHS have also encouraged commercial insurance carriers to make available and increase usage of telehealth services.

The Health Resources Services Administration (HRSA) defines telehealth as the use of electronic information and telecommunications technologies to support this: long-distance clinical health care, patient and professional health-related education, health administration, and public health. Telehealth refers to a broader scope of remote health care services than telemedicine. Telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services, while telemedicine refers specifically to remote clinical services.

One primary action that must be taken is to check with your malpractice insurance carrier to ensure you are covered to provide telehealth services. There is no federal legislation regarding coverage for telehealth services. Licensure is not uniform between states; however, most states have passed laws, and several states have telemedicine licensure bills pending. There are restrictions related to providers doing telehealth with patients in states other than where the provider is located, and cross-border billing does not apply to all licenses. The public health emergency of COVID-19 has created an exception to cross-border care and billing.

Telehealth services requirements must meet medical necessity, be completely documented in the patient's medical record chart, informed consent must be obtained from the patient, and interactive real-time audio/video communications must be conducted with the patient or caregiver. Types of telecommunications are defined by the DHHS and Office of Civil Rights (OCR) and include audio, landline, and wireless communications; text messaging; Internet; video communications; videoconferencing; and store-and-forward imaging. Commercial carriers follow state rules, and currently, 39 states and the District of Columbia have laws relating to telehealth/telemedicine services. Several states have parity laws that state payors will pay the same for telehealth services as in-person rates. The 11 states without parity laws at the time of this article are Alabama, Arizona, Idaho, North Carolina, Ohio, Pennsylvania, South Carolina, Utah, West Virginia, Wisconsin, and Wyoming. This varies by state and may also vary by insurance plan type (health maintenance organization [HMO], preferred provider organization [PPO], point-of-service [POS]), local plans, and exchange plans.

Office of Civil Rights Notification of Enforcement Discretion applies to all HIPAA health care providers, rendering telehealth services under good faith provisions of telehealth during COVID-19 to all telehealth patients until the end of the public health emergency (PHE). If a provider is using good faith, they are using non-public facing communications, and potential HIPAA breaches will not be brought against them. Good faith communications include Apple Facetime, Google Hangouts video, Facebook Messenger video chat, WhatsApp video chat, Zoom, and Skype. However, public-facing communications are considered bad faith and not acceptable. Bad faith communications include TikTok, Twitch, Facebook live, and any public chat room. Providers who can perform these services in a good faith communication portal include physicians, nurse practitioners, physician assistants, nurse midwives, clinical nurse specialists (CNAs), clinical psychologists, licensed clinical social workers, registered dietitians, and nutrition professionals. Providers must practice within their scope of practice and be consistent with Medicare benefit rules and according to Current Procedural Terminology (CPT) codes, which will specify as to type of provider. Unfortunately, physical therapists (PTs), occupational therapists (OTs), and speech language pathologists (SLPs) were not included in the initial expansion, although some facilities may be offering video visits to cash pay patients or under "incident to" rules.