Gastroenterology Coding Alert

Even if your gastroenterology practice isn’t seeing patients with coronavirus, your patients are probably nervous about going out to healthcare offices because they don’t want to risk exposure to coronavirus. Fortunately, those patients can now see your practitioners via telehealth, thanks to new CMS directives that the agency issued last month. Medicare beneficiaries can see their practitioners via telehealth and the MACs will reimburse the practices for these visits.

Background: In the past, only certain visits were payable via telehealth, and only for beneficiaries in rural areas whose telehealth services took place at healthcare offices. 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.”

Remember: Information related to COVID-19 is changing rapidly. This information was accurate at the time of writing. Be sure to stay tuned to future issues of Gastroenterology Coding Alert for more information.

Know Which Codes to Use

If you perform a telehealth visit and you plan to bill your Part B payer for it, you’ll report these services using the same codes you would if you were seeing the patient in your office. For instance, if you see a patient via smartphone for an established patient E/M visit, you will report a code from the 99212-99215 series (Office or other outpatient visit for the evaluation and management of an established patient…).

Example: A 72-year-old patient contacts your office with an exacerbation of Crohn’s disease. She has been experi­encing more abdominal pain and diarrhea than usual but is afraid to come to the office because she is practicing social distancing. The physician performs a telehealth visit with her that includes an expanded problem focused history and medical decision making of low complexity. For this visit, you would report 99213.

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

CMS notes that there are several modifiers you should consider for your telehealth claims, advises Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania:

• 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system)
• GQ (Via asynchronous telecommunications system)
• GT (Via interactive audio and video telecommunication systems)
• G0 (Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke)

Medicare Part B requires the use of modifier 95 on telehealth claims during the extent of the public health emergency. Some commercial payer policies also require that you append modifier 95 to telehealth claims. You should check on individual payer guidelines prior to reporting modifier 95 with your claims for non-Medicare Part B payers.

The remaining three modifiers are based on circum­stantial and/or location considerations. According to CMS, you should only report modifier GQ when the telehealth service is furnished “via asynchronous (store and forward) technology as part of a federal telemedicine demonstration project in Alaska and Hawaii.” Furthermore, modifier GT is designated for billing under Critical Access Hospital (CAH) Method II. Modifier G0 may be used universally among providers and locations so long as the criteria for the modifier has been met.

Virtual Check-ins Are Different

If, instead of a formal telehealth visit, your gastroenterologist has a brief discussion with an established patient to determine whether they need more comprehensive services, you can report a virtual check-in rather than billing a telehealth service. Use these codes for such visits:

• G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 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): This code covers a service via telephone (patient phoning you to provide an update or minor issue), or portal or email exchange.
• G2010 (Remote evaluation of recorded video and/ or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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): You’ll use this code if the patient sends video, images, or other kinds of data transmissions (such as information from a monitor) for your provider to evaluate.

Note the Date of Service for Confirmed Coronavirus Cases

If your practice sees a patient with a confirmed diagnosis of coronavirus, you’ll report B97.29 (Other coronavirus as the cause of diseases classified elsewhere) only for dates of service on or before March 31, 2020. If you see patients with coronavirus on or after April 1, you will instead use the new code U07.1 (COVID-19). You won’t find the latter code in your ICD-10 manual —that’s because the ICD-10-CM Coordination and Maintenance Committee decided on an emergency insertion of this new, more specific code to go into effect April 1.

Breaking news: In the Interim Rule that CMS announced on March 30, telephone services are at least temporarily covered (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.

Furthermore, for telehealth, it appears 2021 has come early: During the COVID-19 emergency, the office E/M level selection can be based on medical decision making (MDM) or time, as time is described for 2021.

Resource: To read the fact sheet about this change, visit the CMS website at https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.