General Surgery Coding Alert

Use these resources for clean claims.

With hundreds of codes added to the list of services covered as telehealth during the public health emergency (PHE) for the COVID-19 pandemic, the following tips should help you stay current on codes and coverage.

Tip 1: Track ‘Temporary’ Telehealth Codes

You can keep track of the most current list of covered telehealth codes, including the most recent quarterly updates, by downloading the latest file at www.cms.gov/Medicare/ Medicare-General-Information/Telehealth/Telehealth-Codes. This file not only lists the codes, but it provides additional information such as when the code was added as part of the PHE and when it may expire.

You should understand that CMS designates some codes on the list as “Category 3” codes. According to the Medicare Physician Fee Schedule Final Rule for 2021, “Category 3 describes services added to the Medicare telehealth list during the [PHE] that will remain on the list through the calendar year in which the PHE ends.” You’ll see the phrase “Available up through the year in which the PHE ends” in the status column of Category 3 codes on the list. You should distinguish that from codes in which the status column states, “Temporary Addition for the PHE for the COVID-19 Pandemic,” because the end dates may be different.

CPT^® is different: You’ll see a 5 point star symbol in CPT^® 2021 that designates codes you can bill as telehealth, according to Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico. Appendix P will also list telemedicine codes. But those codes are only the permanent telehealth services, and you won’t find the temporary telehealth codes marked with a star or on the Appendix P list in CPT^® 2021.

Update: Despite being on the most current list of temporary telehealth codes, CMS published corrections for “technical errors” to the calendar year (CY) 2021 Medicare Physician Fee Schedule (MPFS) in the Federal Register on March 18, including additions previously made to the Medicare telehealth services list. Four codes were “inadvertently” put on the “Category 3” list that shouldn’t have been added, CMS says in the notice. The agency is removing the codes with the change retroactive to Jan. 1, 2021. The four CPT^® codes impacted include:

• 99221-99223 (New or Established Patient Initial Hospital Inpatient Care Services...)
• +96121 (Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour (List separately in addition to code for primary procedure)

Review the notice at www.govinfo.gov/content/pkg/FR-2021-03-18/pdf/2021-05548.pdf.

Tip 2: Master Telehealth Documentation

Coding for telehealth services takes some know-how since you’re often using the same codes you might use in a face-to-face patient encounter.

Here’s how: You should document telehealth services the same way you would for any face-to-face patient encounter, but “you should also indicate that the visit took place via telehealth and the mode of communication, along with the patient’s location, the provider’s location, the names of all persons participating in the telemedicine service, and their role in the encounter,” explained Lori Langevin in a recent NGS Medicare Webinar. “For time-based services, you can document the stop/start time or the total time,” she said.

Don’t forget that “you need to append modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) to services performed via telehealth on or after March 1, 2020 and for the duration of the PHE,” Langevin said. “Modifier 95 indicates to the payer that the service was telehealth, and your payment will not be reduced. Payers other than Medicare may not require this modifier.

Place: The place of service (POS) during the PHE is the same as what it would have been if the visit had happened face to face, such as office or hospital inpatient, according to Medicare rules.

A/V services: Don’t forget that telehealth refers to services that include audio and video components. If you’re coding for a phone-only visit, you should turn to codes such as 99441-99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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…). “These are telephone E/M services,” said Nathan L. Kennedy, Jr., CPC, CHC, CPPM, CPC-I, CPB, CPMA during the NGS Webinar.

Establish care: Suppose you see a new patient via telehealth, and then that person later comes to your office — is that an established patient? “CMS did indicate a few months ago that the new versus established patient guidelines are still in place,” Kennedy said. “So, if you’re providing a professional service to a patient during the PHE, they’ll be an established patient when the PHE is over. CMS has said if anything changes in this regard, they’ll publish additional guidance.”

Keep up with resources: The Feds keep updating telehealth information, which you can access at www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf and www.telehealth.hhs.gov.

Tip 3: Look to Telehealth’s Future

With some temporary telehealth codes slated to expire with the PHE and some at the end of the PHE year, you may wonder if the Feds might make the telehealth changes permanent.

There is legislation in Congress to do so. But without a change to the law, Medicare does not have statutory authority to pay for telehealth to beneficiaries outside of rural areas or, with certain exceptions, allow beneficiaries to receive telehealth in their home, according to MLN Connects Dec 1, 2020 Special Edition.

“The PHE has allowed CMS to bypass the Social Security Act, which is federal law, to allow telehealth services to be performed outside the scope in which they’re defined in that law,” Kennedy said.

However, once the PHE expires, “telehealth services will only be allowed for patients at a distant site, they will only apply to patients who are in rural, underserved areas, and all the legislation will go back into place,” Kennedy noted.

Although the official end of the current PHE extension is April 21, a Department of Health and Human Services (HHS) letter to state governors indicates that the PHE will likely extend through the end of 2021.

“To assure you of our commitment to the ongoing response, we have determined that the PHE will likely remain in place for the entirety of 2021,” HHS Acting Secretary Norris Cochran said in the Jan. 22 letter. “When a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination.”

The letter specifically mentions telemedicine as a tool to increase access to healthcare during a PHE. “Predictability and stability are important given the foundation and flexibilities … that are tied to the designation of the PHE,” Cochran maintains.