ED Coding and Reimbursement Alert

If you’ve heard conflicting advice about how to report telemedicine services in the ED setting, you’re not alone. Fortunately, however, the fog is clearing on how the new telehealth regulations apply to emergency departments.

Background: Practices that have been frustrated about the vast restrictions barring them from reporting telehealth services got some good news in March, when CMS expanded coverage of telehealth services across the board to ensure that Medicare patients don’t have to risk their health to visit emergency departments, potentially subjecting themselves to coronavirus. Instead, Medicare beneficiaries can see their practitioners via telehealth and the MACs will reimburse the practices for such visits.

In the past, only certain visits were payable via telehealth, and only for beneficiaries in rural areas whose telehealth services took place at specifically designated sites of service. Now, CMS will reimburse even if the patients are in their homes during the telehealth visits.

In addition, CMS won’t closely restrict the type of device used for the telehealth visit. Instead, patients can use their computers or smartphones to access face-to-face telehealth services. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus,” said CMS Administrator Seema Verma. “Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

ED Codes Now Allowable Via Telehealth

Although the ED E/M codes were not initially on the list of approved telehealth codes, that changed on March 30, when CMS issued “an unprecedented array of temporary regulatory waivers and new rules to equip the American health care system with maximum flexibility to respond to the 2019 Novel Coronavirus pandemic,” the agency said in a Fact Sheet about the changes.

Retroactive to March 1, 2020, CMS will reimburse practitioners for telehealth services billed with the ED E/M codes (99281-99285), observation codes (99218-99226), and the critical care codes (99291-+99292), among other services. Although these changes are not permanent, they will be on the list throughout the duration of the emergency, said Jeffrey Davis, director of regulatory affairs with the American College of Emergency Physicians.

Here’s the key: To ensure your ED gets reimbursed for telemedicine visits, you should use modifier 95 (Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System) on the majority of your claims, Davis says.

Caveat: You won’t use modifier 95 if you and the patient are in the same location (such as the ED) but the visit takes place via telehealth anyway. In these situations, you can still bill via the telehealth rules, but modifier 95 is not necessary, Davis notes.

Know Which Codes to Use

If you perform a telehealth visit, you’ll report the appropriate codes without having to add any modifiers or additional codes. For instance, if you see a patient via smartphone web call for psychiatric diagnostic evaluation, you’ll report 90791 (Psychiatric diagnostic evaluation).

These services are not restricted to physicians, CMS said. Practitioners such as physician assistants and nurse practitioners can report them also.

EMTALA Exception Arrives

EDs across the country will be glad to hear that they can now use telehealth to fulfill their EMTALA obligations for a medical screening exam, Davis adds.

Phone calls? Don’t bill via telehealth. You cannot bill a telehealth service for an audio-only service. Instead, you must use the telephone codes for those (codes 98966-98968 for nonphysician professionals and 99441-99443 for physicians, PAs and NPs). As of press time, most private payers have not made similar changes.

Resource: To read the updated guidance allowing ED and critical care codes in the telehealth rule, visit https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf.