Neurosurgery Coding Alert

Use this advice to answer future questions.

Most practices have seen an uptick in telehealth appointments, but even as coders get more familiar with submitting claims for these services, confusion still reigns. With all the changes to telehealth over the past few years, though, it’s not surprising that many in the coding world are uncertain which rules have changed and which have stayed the same.

Fortunately, we’ve got answers to many of your telehealth questions to help you stay ahead of the curve.

Keep reading this FAQ for some expert insight into employing this technology and solid tips on coding telehealth encounters.

Question: What Are the Latest Telehealth Updates?

Answer: Telehealth services are prominent in the 2024 Medicare Physician Fee Schedule (MPFS). The Centers for Medicare & Medicaid Services (CMS) plans to implement the 2023 Consolidated Appropriations Act (CAA) telehealth services provisions through the end of 2024. The proposal includes paying the non-facility MPFS rate for at-home telehealth services, lifting geographic restrictions, and allowing Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to provide telehealth services.

Analysis: This kind of convenience and accessibility has the potential to not only free up in-house staff for more appointments, but it could also dramatically improve care quality and compliance.

Telemedicine in 2024: Modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) is no longer required. To get the higher non-facility rate, bill with place of service (POS) 10 when the patient is in their home. POS 02 is for a place of service other than the patient’s home and will be reimbursed at the lower facility rate.

Question: What’s the Correct Way to Code Telehealth Encounters?

Answer: Knowing the correct codes may seem too obvious a point to make, but that’s why it’s often overlooked. As guidelines change, so does the coding, which means you need to stay on top of the most current changes. Additionally, some services require a physician, and some can’t be used if an evaluation and management (E/M) service has been billed in the last seven days. Recognizing the right codes to use will ensure your clinicians are appropriately compensated for their work.

Question: What Are Key Considerations When Seeking a Vendor?

Answer: Do your homework to find the vendor that’s not just great but will also fit the needs of your practice. Even if your practice is already using a telemedicine platform, “it’s worth looking around. The market has matured massively since COVID hit,” says Chip Hart, director of pediatric solutions at Physician’s Computer Company in Winooski, Vermont.

The market is not only maturing, but more players are entering the field. Therefore, finding the right technology to implement can be confusing. “We’ve got a lot of different types of technology. It’s really a noisy space, and it’s making it very difficult for buyers to make a good, solid decision on what’s the right technology pathway to go,” notes Lisa Lavin, founder and CEO, Ōmcare Inc. in Bloomington, Minnesota.

If you’re experiencing this kind of confusion, consider the following:

• User-friendly platform: Healthcare providers and patients should all be able to use the system. If it’s too complicated, no one will want to use it.
• Compliance: Your vendor should prioritize relevant healthcare regulations, such as HIPAA, to ensure patient information is secure.
• Compatibility: You also want to look for a system that can easily integrate with your existing electronic health record (EHR) system. You don’t want a new system to trigger EHR errors. Also, confirm that the internet speed is a good match for the services you’re considering. Some locations don’t have reliable internet, so offering patients accessibility on multiple devices, such as a mobile app or text message, can be a good choice.
• Ongoing support: Be sure to ask about the company’s technical support. Good vendors will provide ongoing support to make sure your system is always up and running.

Question: Is It Necessary to Implement a Training Program?

Answer: There will be a learning curve, even with an easy-to-use technology. Remember, it’s not just about learning new technology. It’s also about integrating new processes into everyday practice. Because of this, you’ll want to establish an organized, clear training program that addresses a variety of in-house processes. The company may offer its own version of this, but consider conducting follow-up training internally to help ensure everyone in the office is on the same page.

In addition to training on the technical aspects of the new platform, here are a few other things to consider:

• Clinical training: Clinicians need to know how to effectively conduct a virtual visit.
• Communication training: Staff must effectively communicate with patients and their families through a virtual platform. This includes both verbal and nonverbal communication skills.
• Legal and regulatory training: Staff need a solid understanding of all aspects of telehealth, including understanding the relevant telehealth laws and regulations in their state, and how to maintain compliance with HIPAA and other privacy laws.
• Emergency procedures training: Establish a protocol and make sure all staff members know how to handle emergencies during a telehealth visit, including when and how to direct a patient to seek immediate in-person care.
• Patient education: Staff also need a full understanding of how to educate patients and their families on how to use the telehealth platform, what to expect during a telehealth visit, and how to prepare for a telehealth visit.

Top tip: Don’t underestimate the role practice schedulers play. This is an area that some practice managers overlook. “Understanding which visits could be done with a simple telehealth visit and which ones require an in-person visit might be the most important success factor,” says Hart.