EM Coding Alert

Question: Our providers are now doing telehealth visits, and the patient is also seen for chemotherapy on the same day. In other words, to reduce the patient’s time in the office and contact with staff members, the patient undergoes a telehealth visit and then comes in for their prescheduled chemotherapy visit. Is it appropriate to attach modifier 25 and modifier 95?

Another question: if the chemo provider does a telehealth visit and the patient receives a port flush (no lab drawn) the same day, can we bill the port flush since it’s telehealth?

Wisconsin Subscriber

Answer: If the visit was in person, you would be able to apply modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service). Therefore, there is no reason this would not be billable if reporting telehealth codes 99441-99443 (Telephone evaluation and management service by a physician or other qualified health care professional …), G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional …), or 99421-99423 (Online digital evaluation and management service, for an established patient …).

This is the same with a port flush using 96523 (Irrigation of implanted venous access device for drug delivery systems). Any time you have an E/M service, you bundle the port flush into that service. You should consider it bundled into telehealth. You can only separately report the port flush when it is the only billable service performed that day.