Gastroenterology Coding Alert

Get helpful reminders on how to stay HIPAA compliant.

The COVID-19 public health emergency (PHE) continues to affect the healthcare landscape and keeping track of the current state of telehealth during this time is making heads spin. If you’re like most coders, you still have many questions as you try to keep up with which services Medicare will continue to pay for, and which waivers they will eliminate once the PHE officially expires.

Read on for a comprehensive breakdown of CMS’ 2023 PHE telehealth updates.

Look Closely at Medicare’s Updated Telehealth E/M Services

As you may recall, the original telehealth service list included the following codes: observation care discharge service code (99217), initial and subsequent observation care codes (99218- 99220, 99224-99226), initial and subsequent hospital care codes (99221-99223, 99231-99233), observation or inpatient hospital care with same day admission and discharge codes (99234- 99236), and hospital discharge day management service codes (99238-99239).

However, as we have reported in previous issues of Gastroenterology Coding Alert, the American Medical Association (AMA) revised many of these evaluation and management (E/M) CPT^® codes for 2023. AMA has deleted hospital observation codes 99218-99220, 99224-99226, and 99217; revised the inpatient and observation care codes into codes 99221-99223 (initial) and 99231-99233 (subsequent); and revised the inpatient/observation same-day discharge codes 99234-99236, effective Jan. 1, 2023.

Consequently, “as expected, CMS eliminated the observation codes mentioned above from the telehealth code list. Additionally, CMS eliminated +99356 [Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour…] and +99357 [… each additional 30 minutes…] from the telehealth list as CPT^® has eliminated these codes effective Dec. 31, 2022,” notes Kelly Loya, CPC, CHC, CRMA, CPhT, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services, Charlotte, North Carolina.

CMS and CPT^® have replaced the codes with +99418 (Prolonged inpatient or observation evaluation and management service(s) time ….) for non-Medicare patients and HCPCS Level II code G0316 (Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service …) for Medicare patients. As you would expect, G0316 is the only one of these two codes added to the 2023 telehealth list.

Coding alert: With the introduction of these codes, CMS and CPT^® have continued their disagreement about when you can apply prolonged service codes to the primary service. Stay tuned to future issues of Gastroenterology Coding Alert for more information.

You can find the most recent approved telehealth list at www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.

Prepare to Go Back to These Place-of-Service Codes

Under the final rule for 2023, CMS is continuing to let providers bill for place of service (POS) as if the telehealth service was furnished in person, which would typically be the office. This means you do not need to use POS 02 (Telehealth provided other than in patient’s home) or POS 10 (Telehealth provided in patient’s home); instead, you may use a code such as POS 11 (Office) if that is where your provider would have normally performed the service in person.

Note: Though beneficiaries are not limited to qualifying ZIP codes or locations, such as facilities or physician office, you should still be mindful of where the provider rendering the services is located. Local state restrictions for rendering medical care across state lines and practice scope limitations along with payer rules and requirements, may limit your ability to bill out-of-state patients for telehealth services. You can begin your research to find out if your practice is compliant with the current telehealth guidelines by going to telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/telehealth-licensing-requirements-and-interstate-compacts/.

Post-PHE: The final rule stipulates that when the PHE ends, providers will need to adapt to a post-COVID coding landscape. Starting on the 152nd day after the PHE concludes, providers will need to indicate the appropriate POS code, the agency says, and CMS has finalized the use of POS 02 and 10 once again as appropriate.

Understand Audio-Only Interaction

Currently, providers can offer “certain counseling behavioral health care and educational services” as audio-only, such as 99497/+99494 (Advance care planning… first 30 minutes/ each additional 30 minutes…), according to CMS. Also, your practice can offer 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services …; 5-10 minutes of medical discussion), 99442 (… 11-20 minutes of medical discussion), or 99443 (… 21-30 minutes of medical discussion) as telephone/audio-only services if they are conducted by physicians or other qualified healthcare professionals (QHPs) as the descriptor states. Medicare coverage of 99441-99443 expires with the PHE plus 151 days.

Remember: Physicians and QHPs must meet and follow current CPT^® guidelines for the services. Again, you should consult the Medicare telehealth services list for the current status of services that can be provided as audio-only.

Modifier alert: For qualifying audio-only services, you can select either Medicare modifier FQ (The service was furnished using audio-only communication technology) or CPT^® modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system). Modifier FR (The supervising practitioner was present through two-way, audio/video communication technology) is also still available for use on applicable claims.

Post-PHE: “Following the 151-day post-PHE extension period, CMS will once again assign the telephone E/M services a ‘bundled’ status, which means Medicare will no longer separately pay for them,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Know How to Stay HIPAA Compliant During Sessions

During the PHE, CMS is allowing providers to use “popular non-public facing applications that allow for video chats … without risk of penalty for noncompliance with the HIPAA Rules.” This means providers and patients can currently use such popular audio/video platforms as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype” for “all services on the Medicare telehealth list,” according to an FAQ published by CMS (www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf, page 74).

Keep an Eye Out for Updates on End Dates

Currently, the COVID-19 PHE has been extended until January 11, 2023 (see aspr.hhs.gov/legal/PHE/Pages/ covid19-13Oct2022.aspx). But in a letter to state governors, the Biden administration indicated “when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination” of the PHE end date. This means, “at present, if the PHE expires on Jan. 11, 2023, the availability of telehealth and the rules applicable during the PHE will extend 151 days after the PHE end date. At this point, that would be June 11, 2023, far into the second quarter of 2023,” notes Leah Fuller, CPC, COC, senior consultant, Pinnacle Enterprise Risk Consulting Services, in Charlotte, North Carolina.