Introduction to Telehealth Coding

Clinical Issues and Solutions/Documentation Guidance

Susanne Talebian, CUA, CPC-I, CPC

Disclosures

Urol Nurs. 2020;40(4):195-200. 

In This Article

Patient Home-based Services

Remote Psychologic Monitoring (RPM) codes are intended for use in the diagnosis of disease or other conditions, treatments, or prevention of disease. RPM is not considered general telehealth, and therefore, is not subject to those same restrictions under Medicare. It is not limited by geography to rural or medically underserved areas, nor is there any "originating site" restriction. RPM services can be provided anywhere the patient is located, including at the patient's home.

The 2018 Medicare Physician Fee Schedule (2018 MPFS) was created for the first-time reimbursement opportunity for physicians and other qualified health care professionals:

  • Depending on state scope of practice,

  • CMS or other payer's guidelines,

  • Qualified by education, training, licensure/regulation

  • Who independently report their services include nurse practitioners, physician assistants, clinical nurse specialists, clinical nurse managers, clinical registered nurse specialists, certified social workers, physical therapists,

  • Who utilize RPM services billed via CPT Code 99091.

The final 2019 Medicare Physician Fee Schedule created several additional RPM codes for 2019 in the categories of Virtual Check-Ins, Remote Evaluation of Patient-Submitted Images and Video, Interprofessional Internet Consultations, and RPM. These services increase access to care and provide an opportunity to catch medical alerts for early intervention. This includes clinical data, such as blood pressure, temperature, weight gain/loss, and glucose and urine volume. Under the CARES Act, consent can be obtained at the initial visit. The series of codes are 99453, 99454, 99457, and +99458 (Box 2 and Box 3).

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