Coding Advice for Telephone Versus Telehealth Care

It can be hard to stay on top of coding updates under normal circumstances, let alone during a pandemic. That's especially true when it comes to Telehealth, telephone visits, and the rapidly expanding coverage of remote care.  

Speaking with Medscape, coding expert Betsy Nicoletti, MS, provided insight for practices looking to weather the coronavirus pandemic and still receive payments for remote services. “With all of the changes that CMS has implemented since the beginning of the COVID-19 crisis, this one has generated a great deal of questions,” Nicoletti says of Telehealth coding.

Coding for Phone Visits

At the end of April, the Centers for Medicare and Medicaid Services (CMS) increased the payments for telephone visits and added codes to their Telehealth list:

99441: Telephone E/M service by a physician or other qualified healthcare professional who may report E/M services provided 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; 5-10 minutes of medical discussion.

99442: 11-20 minutes of medical discussion

99443: 21-30 minutes of medical discussion

But at the same time, CMS is waiving the need for these codes to apply only to established patients. They can be used with new patients as well. 

These three codes have been brought in-line with the reimbursements received for in-office visits of the same length, specifically CPT codes 99212-99214.

Nicoletti continues to clarify, “For Medicare, do not use place of service 02 (telehealth) for codes on the telehealth list. Use the place of service where the service would have been furnished if done face-to-face. For phone calls, this is most likely to be [the] office or outpatient department. Do add modifier -95 to the codes for Medicare services, however.”

Coding for Other Telemedicine Visits

Other Telehealth services are slightly more clear cut. Office billing codes 99201-99215 all appear on CMS’s list of approved Telehealth codes, meaning they require real-time, audio, and visual communication. Additionally, CMS is allowing physicians to bill according to the time or medical decision.  

Meanwhile, codes 99421-99423, G2010 and G2012, referring to online evaluation and management (E/M) services and other virtual communications, are still not on the Telehealth coding list. As such, physicians should not use POS 02 or modifier 95 with them. 

CMS recently announced they are opening up the list of Telehealth coverage for submissions from practitioners. For more on their growing Telehealth coverage, you can find all the details on their webpage.