Internal Medicine Coding Alert

Modifier 95, Appendix P, and POS code 02 let you communicate effectively with Medicare.

CPT^® 2017 offers you several new telemedicine concepts to master; including a place  of  service  (POS)  code,  appendix,  symbol,  and  modifier.

In short: The new Appendix P alone contains 34 evaluation and management (E/M)  codes,  and  although  all  of  the  codes  in  the  appendix  aren’t  new,  having  them  in one location is a great reference tool.

Stay ahead of the telemedicine curve by learning what you need to know about telemedicine today.

Learn How Medicare Defines Telemedicine Services

Medicare.gov  classifies  telemedicine  as  “medical  or  other  health  services  given  to  a  patient  using  a  communication  system  (like  a  computer,  phone  [with  two-way  visual  capabilities],  or  television)  by  a  practitioner  in  a  location  different  than  the  patient’s.”

If the telemedicine service meets all of the following stipulations, Medicare will pay both a facility fee to the originating site and a separate payment to the distant site practitioner who provided the service:

• A  physician  or  other  authorized  practitioner  must  provide  the  telemedicine  service.
• The  patient  who  receives  the  telemedicine  service  must  be  enrolled  under  Medicare  Part  B  and  receive the  service  at  an  accepted  telemedicine  originating  site.
• The  qualified  physician  must  employ  interactive,  real-time,  two-way  telecommunications equipment that includes both audio and video when he provides the telemedicine service.
• The service must appear on Medicare’s list of approved telemedicine services. Access the list here: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html.

Fun fact: You  can  submit  a  request  to  add  a  service  to  Medicare’s  telemedicine  services  list.  Just  ensure  that  you  follow  CMS’s  criteria  —  also  available  on  the  website.

More info: To  learn  more  about  Medicare’s  telemedicine  service  requirements,  you can reference the 2017 Physician Fee Schedule Final Rule available under “Related Links” at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1654-F.html.

Using the New Appendix P and Star Symbol

The 2017 AMA CPT^® manual gives you a brand-new appendix, Appendix P, which provides guidance for the 79 codes you can use with modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) to report real-time, remote telemedicine services, according to Mary I Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pa.

CPT^® 2017 designates the relevant telemedicine codes that also appear in Appendix P with a star (*) symbol next to the code in the code set.

Your  Appendix  P  options  for  E/M  include  these  codes:

• 99201-99205, Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components …
• 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components …
• 99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components …
• 99241-99245, Office consultation for a new or established patient, which requires these 3 key components …
• 99251-99255, Inpatient consultation for a new or established patient, which requires these 3 key components …
• 99307-99310, Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components …
• 99354 and 99355, Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service …  
• 99406 and 99407, Smoking and tobacco use cessation counseling visit …
• 99408 and 99409, Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services …
• 99495 and 99496, Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period face-to-face visit … 

Say Hello to New POS Code 02

CMS also created a new place of service (POS) code for telemedicine: POS 02 (Telehealth: The location where health services and health related services are provided or received, through a telecommunication system), according to an MLN Matters article. Head to www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9726.pdf to read the full article.

Urgent: According to CMS, physicians working from a distant site who do not use POS 02 when reporting their telemedicine services will receive a denial, effective Jan. 1, 2017.

Know What Sets Modifiers GT/GQ, Modifier 95 Apart

When you report telemedicine services with POS code 02, Medicare requires you to append either modifier GT (Via interactive audio and video telecommunication systems) or GQ (Via asynchronous telecommunications system) to your CPT^® or HCPCS code. Your Medicare Administrative Contractor (MAC) will deny the service if you use the POS code 02 without the appropriate GT or GQ modifier, or vice versa.

For 2017, CPT® gives you a new telemedicine modifier — 95 — to report telemedicine services your physician provides via real-time, interactive audiovisual telecommunications.

Important: “Only  when  the  95  modifier  and  the  correct  POS  of  02  are  indicated  on  the  claim  will  it  be  considered  for  reimbursement  by  most  payers  that  don’t  recognize  the  GT  modifier,”  says  Suzan Hauptman, CPC, CEMC, CEDC,  senior  principal  of  ACE  Med  group  in  Pittsburgh,  Pa.

Falbo provides further insight into the telemedicine modifiers.

“Currently,  CMS  has  HCPCS  modifier  GT  to  identify  synchronous  service  via  interactive  radio  and  video  telecommunications  system,  which  is  not  accepted  by  all  payers,”  Falbo  says.  “Therefore,  modifier  95  has  been  developed  to  provide  a  reporting  mechanism  that  is  similar  to  CMS  and  possibly  other  payers  who  recognize  GT.”

Remember: Practices should always check with the payers on telemedicine coverage policies and the use of the appropriate modifier — 95 or GT, according to both Hauptman and Falbo.

---