# Virtual Visits



## gailmc (May 26, 2011)

We are just starting to provide virtual visits - patient video-conferencing from home discussing medical condition with physician in office - and I am wonder what is the correct POS of use?  Does anyone have any experience with this?


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## mitchellde (May 26, 2011)

you would still use 11 but what CPT code are you using?  I am thinking this comes under the definition of online for 99444 as it does say this is for any electronic communications network.


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## gailmc (May 31, 2011)

The telehealth guidelines from CMS indicates we can use office visits with a -GT modifier.  Usually the patient and the provider are in the same POS, so is the POS determined by where the patient is or by where the provider is?


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## mitchellde (May 31, 2011)

As long as this is a Medicare patient and you are located in one of the defined areas to provide telehealth and the patient is located in a defined location then you use POS for where the provider is.


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## gailmc (May 31, 2011)

These are not Medicare patients utilizing telehealth, but patients with commercial insurance receiving care from a provider while in the comfort of their home and the provider is in their office.  We do have E-visits, but this is different because the patient is being seen via videoconference software like Skype.  I am confident we can use the E/M services with a -GT modifier, but am unclear on the correct POS.


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## mitchellde (May 31, 2011)

I would check with the commercial carriers first as to whether they recognize the GT modifier, as it is a carrier discretion modifier.  Also as I said make sure you have met the definition of the use of the GT modifier with respect to location geographically.  The reason I suggested the 99444 is it states this is via the internet or "other similar electronic communications network".     
For the GT modifier:
an originating site located in either a rural Health Professional Shortage Area (HPSA) as defined by §332(a)(1) (A) of the Public Health Services Act or in a county outside of a Metropolitan Statistical Area (MSA) as defined by §1886(d)(2)(D) of the Act. 
Exception to rural HPSA and non-MSA geographic requirements. Entities participating in a federal telemedicine demonstration project that were approved by or were receiving funding from the Secretary of Health and Human Services as of December 31, 2000, qualify as originating sites regardless of geographic location. Such entities are not required to be in a rural HPSA or non-MSA.

Originating site defined. An originating site is the location of an eligible Medicare beneficiary at the time the service being furnished via a telecommunications system occurs. Originating sites authorized by law are listed below.

    The office of a physician or practitioner.
    A hospital.
    A critical access hospital.
    A rural health clinic.
    A federally qualified health center

The originating site must be located in a rural HPSA or non-Metropolitan


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## mitchellde (May 31, 2011)

I am not sure that was clear but if you read carefully you will see that the patient cannot be at home for telehealth.  They must be in a defined originating location, your physician is then in what is referred to as the distant location.  And the originating site must be geographically located in an underserved area.  This was the whole point of the GT modifier so that physician in rural areas could teleconference with other providers and specialists while the patient is there.


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## gailmc (May 31, 2011)

Again, these are not telehealth visits, but virtual visits.  I am well aware of the Telehealth Guide for Medicare patients, but since that is not the service I am referring to, the guidelines do not apply.  The -GT modifier indicates only that the interaction needs to be via interactive audio and video telecommuncation systems.  It says nothing about location of the patient - it does say that in the Telehealth Guidelines, which does not apply to the service I am asking about. In MN the -GT modifier is accepted by all payers because we have adopted the Administrative Simplification Act, so that is not a concern for me.  Thank you for the information, but I will continue to seek information from clinics/hospitals that provide virtual visits.


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## mitchellde (May 31, 2011)

I am sorry I do disagree with the interpretation of the GT modifier.  It was created for a specific service identified as Telehealth which has a specific definition.. You cannot change the definition of a modifier or service.  To date there has been no provision for the delivery of health services via the virtual visit with the exception of the 99444.  That is why in the 99444 descriptor they added the phrase I referred to above which would include the type of encounter you are referring to.


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