Gastroenterology Coding Alert

Question: My provider wants to bill 99350 when performing a home visit via telehealth video. The patient is in their home at the time of service. It seems to me if the doctor is in the office performing the visit over a video call, the criteria aren’t met for a home visit. Is this the correct code to use, or should I report a standard office evaluation and management (E/M) code?

AAPC Forum Participant

Answer: The telehealth version of any E/M visit will never be able to meet all the criteria for a face-to-face visit, simply because of the nature of virtual visits. When to use 99341-99350 (Home or residence visit for the evaluation and management of a/n new/ established patient…) versus 99202-99215 (Office or other outpatient visit for the evaluation and management of a/n new/ established patient…) basically comes down to intent. The Centers for Medicare & Medicaid Services (CMS) accepts both code sets in telehealth situations, but which code is correct depends on the details of the situation.

If the telehealth visit was in place of a face-to-face home visit, you can report 99341-99350. However, keep in mind you will still need to make sure that you’re able to support medical necessity for the visit to occur at home, and meet any other criteria that the payer would ordinarily require. If the telehealth visit was in place of a face-to-face office visit, report 99202-99215. Again, regardless of which code you report, check with the payer to make sure you are able to meet the documentation requirements.

Also be mindful of modifiers and place of service codes in reporting the services. Telehealth services rendered via video should include modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) appended to the code. Further, regardless of which code you report, the place of service code will be 10 (Telehealth provided in patient’s home).