Ophthalmology and Optometry Coding Alert

Question: How long are we allowed to bill telehealth under the relaxed rules? Our office is only seeing patients with urgent conditions right now in person, and the rest of our visits are taking place over Skype and FaceTime. Also, which place of service (POS) should we use?

Minnesota Subscriber

Answer: In the past, telehealth was only payable by Medicare if patients were in a specific health setting during the visit, and only when certain technologies were used, but as you noted, this has changed due to the coronavirus pandemic. To determine how long you can continue billing this way, check out Medicare’s language in its March 31 MLN Connects Special Edition newsletter:

“When billing professional claims for non-traditional telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with the POS equal to what it would have been in the absence of a PHE, along with a modifier 95, indicating that the service rendered was actually performed via telehealth. At this time, there is no end date to the PHE.” Thus, you should stay on top of how long the PHE lasts and make sure you are aware of when CMS ends the special telehealth regulations.

The use of modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) tells the payer that you performed the service via telehealth, while using your POS (such as 11 for the office) tells the insurer that the ophthalmologist was based in the office when the telehealth visit took place.

Don’t do this: Practices should avoid adding the POS for telehealth (02) to these claims during the PHE. Although that’s traditionally the right POS for telehealth, that’s not how things work during the pandemic under CMS’ relaxed rules. And some payers are reminding practices that you can never report more than one POS on your paper claims.

Putting it all together: Suppose you see an established glaucoma patient for a six-month evaluation of their condition. The visit takes place via Skype, and the ophthalmologist is in the office, while the patient is in their home. The documentation describes an expanded problem focused history and medical decision making (MDM) of low complexity. Based on the details of the visit, the ophthalmologist calls in a renewal of the patient’s current eyedrop prescription to the pharmacy and notes that the patient seems to be tolerating the medication well. For this visit, the physician will report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components…) with modifier 95 appended. They will use POS 11 and the appropriate ICD-10 code, such as H40.20X1 (Unspecified primary angle-closure glaucoma, mild stage).