General Surgery Coding Alert

Question: Our surgeon had a telehealth visit with a patient that resulted in the patient coming to the office for an exam. Should we charge telehealth, office, or both?

Codify Subscriber

Answer: To report 99441-99443 (Telephone evaluation and management service by a physician or other qualified health care professional …) or G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional …), you must make sure services have not originated “from a related E/M service provided within the previous seven days nor leads to an E/M service or procedure within the next 24 hours or soonest available appointment” per the code descriptors.

Similarly, 99421-99423 (Online digital evaluation and management service, for an established patient …) must not originate from a related E/M service either seven days before or after the contact.

Action: That means you should incorporate the work involved in the telehealth visit into the appropriate code for the office visit, choosing the appropriate code from the range 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …). You should not report two visits, and you shouldn’t use a telehealth modifier.