Ophthalmology and Optometry Coding Alert

Answer: Before billing 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 [evaluation and management] service provided within the previous 7 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.

Bottom line: The work involved in the telehealth visit is incorporated into the separately reported 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …) office E/M if the telehealth visit results in an office E/M service during the before-and-after timeframes associated with the codes. You wouldn’t need the telehealth modifier, and you would only document the resulting E/M service.