Ophthalmology and Optometry Coding Alert

You have until the end of the public health emergency to collect for these services.

Your eye care practice is likely to be performing telehealth services almost every day during the coronavirus pandemic, but it’s also possible that your optometrists and ophthalmologists are handling some patient encounters over the phone. If you’ve been confused about how to handle phone visits, CMS offered some clarity in the form of an April 30 update that lays down specific rules about these encounters.

Background: Although telehealth visits (which require two-way synchronous real-time communication via audio-visual technology) are now the norm for many non-emergent evaluations, not all patients are equipped to speak to their physicians this way, and some are instead requesting phone visits, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania. Fortunately, during the public health emergency (PHE), CMS also adds audio phone calls as covered services.

In black and white: “A broad range of clinicians, including physicians, can now provide certain services by telephone to their patients (CPT^® codes 98966 -98968; 99441-99443),” CMS says in a March 30 fact sheet.

Consider these three facts as you navigate the phone coding maze. Keep in mind that information related to COVID-19 is changing rapidly. This information was accurate at the time of writing. Be sure to stay tuned to future issues of Ophthalmology Coding Alert for more information.

1. Know the Telephone Codes That Medicare Requires

When you see a Medicare patient for a telephone interaction, you should report:

• 99441 (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; 5-10 minutes of medical discussion)
• 99442 (… 11-20 minutes of medical discussion)
• 99443 (… 21-30 minutes of medical discussion)

Example: An established patient calls the ophthalmologist to discuss a recent blepharitis exacerbation. The physician discusses ways the patient can maximize their use of hot compresses and daily cleansings to quell the symptoms. The total phone call time is 15 minutes.

How to code this: For Medicare patients, you’ll code this as a telephone service using 99442, since the service meets the criteria that the patient initiated the call, and that a physician or other qualified healthcare professional has provided the service. You’ll link 99442 to the appropriate diagnosis code, such as H01.0 (Blepharitis).

Private payer note: Some regions have dictated that private payers not only reimburse phone visits using the same payment schedule as telehealth codes during the pandemic, but they also require the visits coded as if they were office visits, rather than using telephone service codes, says Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a physician and former CPT^® Editorial Panel member in Pasadena, California. “So for your larger payers, check their bulletins or websites for coding instructions,” he says.

Don’t Stress about Using These Codes for New Patients

Several coders have contacted Ophthalmology Coding Alert to express concern about the fact that the telephone code descriptors all use the words “established patient.” In reality, eye care physicians get calls from new patients with emergent conditions all the time, causing many people to wonder how to designate a patient phone call for these patients. Fortunately, CMS addressed that issue also, noting that it softened the “established patient” rules surrounding these codes.

In black and white: “We believe it is important during the PHE to extend these services to both new and established patients,” CMS says in the interim final rule issued on March 31. “While some of the code descriptors refer to ‘established patient,’ during the PHE we are exercising enforcement discretion on an interim basis to relax enforcement of this aspect of the code descriptors. Specifically, we will not conduct review to consider whether those services were furnished to established patients.”

Latest Changes Boost Phone Pay

Although you may be accustomed to CMS maintaining a low payment amount for phone visits, that changed for the better thanks to recent updates to the regulations.

In black and white: “CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits,” the agency said in an April 30 update to its PHE telehealth regulations. “This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.”

This appears to echo the rules dictated by several private payers. For instance, Anthem Blue Cross states in its Medi-Cal Managed Care Telehealth COVID-19 Q&A, “Health plans shall provide the same amount of reimbursement for a service rendered via telephone as they would if the service is rendered via video, provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the enrollee.”