Introduction to Telehealth Coding

Clinical Issues and Solutions/Documentation Guidance

Susanne Talebian, CUA, CPC-I, CPC

Urol Nurs. 2020;40(4):195-200.

Conclusions

During the COVID-19 pandemic, we are all facing a significant decrease in services and revenue, and we are learning how to implement and code for telemedicine, telehealth, and other technology-based services that we may not have previously been providing. COVID-19 has brought to reality the applications of telemedicine and telehealth services that both providers and patients will find convenient, time-efficient, and well-structured. This is the time to accept, prepare, and ramp up for these services to continue through COVID-19 and beyond. One word of caution is to realize that the DHHS is currently allowing us to use non-HIPAA-compliant platforms, and providers must be ready to make the change to HIPAA-compliant platforms going forward. This offers some time to research and evaluate the right platform for your clinic, along with looking at integrating RPM services into your practice for better patient care and outcomes and generate additional revenue. Working through these issues is what your billing team and outside consultants can do to get you on the right path to proper reimbursement and to successful telehealth, telemedicine, and technology-based, revenue-generating, remote physiological monitoring programs.

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Cite this: Introduction to Telehealth Coding - Medscape - Jul 01, 2020.

Table 1. Billing Codes Based on Time in Minutes
Code	CPT	CMS
99201	10	17
99202	20	22
99203	30	29
99204	45	45
99205	60	67
99212	10	16
99213	15	23
99214	25	40
99215	40	55

Table 2. Non-Face-to-Face Evaluation and Management Services
Visit Type	Description	Codes
eVisits – Online Digital visits	Patients must generate the initial inquiry, and communications can occur over a 7-day period via a patient portal, and can be rendered by practitioners who may independently bill Medicare for evaluation and management visits.	Cumulative, time-based codes for a 7-day period, cumulative time during the 7 days.	99421: 5–10 minutes
			99422: 11–20 minutes
			99423: 21 minutes or more
eVisits – Online Digital visits for Non-MD	Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists, dieticians) can provide these e-visits.	Online digital evaluation and management service for an established patient for up to 7 days, cumulative time during the 7 days.	G2061: 5–10 minutes
			G2062: 11–20 minutes
			G2063: 21 minutes or more
Telephone calls – Audio only rendered by physician or other qualified health care professional	Telephone evaluation and management service provided by a provider to an established patient, parent, or guardian point-of-service plan normally rendered in office but may also be rendered from the provider's home (provider's home address does not need to be listed claim forms).	Not originating from a related evaluation and management (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.	99441: 5–10 minutes of medical discussion
			99442: 11–20 minutes
			99443: 21 or more minutes
Telephone calls – Audio only rendered by non-physician non-qualified health care professional	Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists, dieticians).	Not originating from a related assessment and 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.	98966: 5–10 minutes of medical discussion
			98967: 11–20 minutes
			98968: 21 or more minutes
Interprofessional Telephone/Internet Services	Interprofessional telephone/Internet assessment and management service provided by a consultative physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional. Note: This can only be billed by the consulting physician.	Billed on time spent. Provider can be a medical doctor, nurse practitioner, or physician assistant. Do not bill more than once in 14 days.	99446: 5–10 minutes of medical consultative discussion and review
			99447: 11–20 minutes
			99448: 21–30 minutes
			99449: 31 minutes or more
	Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician can be rendered for new or established patients. Note: This can only be billed by the consulting physician.	Includes a written report to the patient's treating/requesting physician or other qualified health care professional.	99451: 5 or more minutes of medical consultative time
	Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health care professional, 30 minutes of medical consultative time. Note: This can be billed by the requesting physician or qualified health care professional.	Must meet the greater than 50% rule on time.	99452: 30 minutes of medical consultative time.

Table 3. Confirmed COVID-19 Case
Confirmed COVID-19 Case
U07.1	COVID-19, CONFIRMED cases by local or state testing or CDC.
U07.1	COVID-19 asymptomatic individuals who test positive for COVID-19. This is a new code that will be in the 2020 ICD10CM update to release on October 1, 2020.
For Screening of Patients
Z11.59	Encounter for screening for other viral diseases. For asymptomatic individuals who are being screened due to a possible or actual exposure to COVID-19 and have no known exposure to the virus, and test results are either unknown or negative.
Z03.818	Encounter for observation for suspected exposure to other biological agents (COVID-19) ruled out.
Z20.828	For cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) COVID-19, and the exposed individual either tests negative or the test results are unknown.
For Manifestations and COVID-19
U07.1	COVID-19 Sequenced first, followed by the appropriate codes for associated manifestations Examples: J12.89 Other viral pneumonia. J20.8 Acute bronchitis due to other specified organisms
	Obstetrics patients O98.5 Other viral diseases complicating pregnancy, childbirth, and the puerperium (U07.1 would follow when coding)

Table 4. Remote Physiologic Monitoring Services
99453	Remote monitoring of physiologic parameter(s), initial; set-up and patient education on use of equipment.	Device must be used greater than 16 days to bill this code. Bill once per episode of care. Defined as from initiation of the Remote Physiologic Monitoring program until the patient reaches their specific goals.
99454	Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.	Report when recordings/programmed alerts greater than 16 days to bill this code. Bill every 30-day period. Device must meet FDA requirements of a medical device.
99457	Remote Physiologic Monitoring Treatment Management Services, initial 20 minutes or more professional time in a calendar month requiring live, interactive communication with the patient/caregiver during the month.	Must meet the full 20 minutes during a calendar month to bill this code.
+99458	Remote Physiologic Monitoring Treatment Management Services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month, subsequent 20 minutes.	Must meet the full additional 20 minutes to bill this add-on code. You cannot bill a fraction of the time. Maximum of two units per month.

Notes:
Remote Physiologic Monitoring
• Intended for the 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.
• Nor is it 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.
Requirements
• Advanced beneficiary consent.
• Ordered by QHCP.
• Face-to-Face visit with QHCP in past 12 months .
• Patient has received, from my practice, a medical device capable of wirelessly transmitting patient data and/or alerts daily to our practice.

Box 1. Documentation Example: Telehealth Services
This service is being rendered via telecommunications. The patient is aware of this and accepts any possible HIPAA risks and agrees to proceed. The encounter was started at XX AM/PM and ended at XX AM/PM Total of ___ minutes The patient is located at ________________ The provider is located at ________________

Box 2. Documentation Example: Patient Home-Based Services
Date of Encounter: __________________________________ Patient's Name: _____________________________________ Appointment with provider: ___________________________ Chief complaint: Reason for the visit in the patient's owns words______________________________________________ We discussed treatment options including doing nothing, prescribed medications, invasive procedures, and commitment to self-care. Diagnosis and treatment plan are as follows: ___________ ____________________________________________________ Diagnosis:__________________________________________ Specific patient goals are: ____________________________ ____________________________________________________ Defined, set, and documented in the patient record. The patient has freely chosen and is willing to proceed with a remote physiological monitoring program. We will proceed with patient education and initial setup of the device. We have provided a medical device with daily recordings or alerts. The patient understands that compliance and adherence to this program is necessary to reach the goals and improve their health. Provider name, signature, date:_______________________ ____________________________________________________

Box 3. Documentation Example: Interprofessional Telephone/Internet Services
This Interprofessional service is being rendered via telecommunications. Requesting QHCP Consulting Physician The encounter was started at XX AM/PM and ended at XX AM/PM Total of ______ minutes Continue with your discussion… The consulting physician provided and documented the verbal and sent the written report to the requesting physician.

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Introduction to Telehealth Coding

Clinical Issues and Solutions/Documentation Guidance

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