Ophthalmology and Optometry Coding Alert

Get to know how the rules changed in March.

Your ophthalmology practice may not be confirming a lot of coronavirus cases, but your patients are probably nervous about going out to healthcare offices because they don’t want to risk exposure to coronavirus. The good news is that those patients can now see your practitioners via telehealth visits.

Background: In the past, only certain visits were payable via telehealth, and only for beneficiaries in rural areas whose telehealth services took place at healthcare offices. In March, CMS announced that Medicare payers will reimburse you for telehealth visits even if the patients are in their homes during the encounters.

In addition, CMS won’t closely restrict the type of device used for the telehealth visit. Instead, patients can use their computers or smartphones to access face-to-face telehealth services. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus,” said CMS Administrator Seema Verma. “Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

Remember: 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 Which Codes to Use

If you perform a telehealth visit and you plan to bill your Part B payer for it, you’ll report these services using the same codes you would if you were seeing the patient in your office, with one important exception. Although the codes from the 99212-99215 series (Office or other outpatient visit for the evaluation and management of an established patient…) are on the list of covered telehealth services, the general ophthalmological services codes (92002-92014, Ophthalmological services: medical examination and evaluation ...) are not. Therefore, this is one case where you won’t have to wonder whether you should report the eye codes or the E/M codes. For telehealth visits, you should choose the E/M codes, assuming your documentation supports them.

Example: A 72-year-old patient contacts your office with an exacerbation of blepharitis. She has been experiencing more dryness than usual and has a stinging sensation in her left eye, but is afraid to come to the office because she is practicing social distancing. The physician performs a telehealth visit with her that includes an expanded problem focused history and medical decision making of low complexity. For this visit, you would report 99213.

These services are not restricted to physicians, CMS said. Practitioners such as physician assistants and nurse practitioners can report them also.

CMS notes that there are several modifiers you should consider for your telehealth claims, advises Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania:

• 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system)
• GQ (Via asynchronous telecommunications system)
• GT (Via interactive audio and video telecommunication systems)
• G0 (Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke)

Medicare Part B requires the use of modifier 95 on telehealth claims during the extent of the public health emergency. Some commercial payer policies also require that you append modifier 95 to telehealth claims. You should check on individual payer guidelines prior to reporting modifier 95 with your claims for non-Medicare Part B payers.

The remaining three modifiers are based on circumstantial and/or location considerations. According to CMS, you should only report modifier GQ when the telehealth service is furnished “via asynchronous (store and forward) technology as part of a federal telemedicine demonstration project in Alaska and Hawaii.” Furthermore, modifier GT is designated for billing under Critical Access Hospital (CAH) Method II. Modifier G0 may be used universally among providers and locations so long as the criteria for the modifier has been met.

2. Virtual Check-ins Are Different

If, instead of a formal telehealth visit, your ophthalmologist has a brief discussion with an established patient to determine whether they need more comprehensive services, you can report a virtual check-in rather than billing a telehealth service. Use these codes for such visits:

• G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 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): This code covers a service via telephone (patient phoning you to provide an update or minor issue), or portal or email exchange.
• G2010 (Remote evaluation of recorded video and/ or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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): You’ll use this code if the patient sends video, images, or other kinds of data transmissions (such as information from a monitor) for your provider to evaluate.

Billing note: CMS outlines that the Office of Inspector General (OIG) will provide “flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.” Marie Popkin, CPC, CMCS, BSM, ProFee auditor at HCCS HIM Services in Fort Myers, Florida, explains what exactly that does, and does not, mean for physician practices. “In order to fully understand how this translates to your practice, you need to first check payer policy. One common assumption is that you have to submit an appeal when the copay is not covered by the payer following reimbursement. However, that’s only true if your local carrier is picking up the copay. I’ve yet to see this be the case, but you’ll want to make sure to confirm that policy in writing,” advise Popkin.

3. Telephone Visits Covered, Codes Can Be Based on Time

In the interim rule that CMS announced on March 30, telephone services are at least temporarily covered (codes 98966-98968 for nonphysician professionals and 99441-99443 for physicians, PAs, and NPs). As of press time, most private payers have not made similar changes.

Furthermore, for telehealth, it appears 2021 has come early, says Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a physician and former CPT^® Editorial Panel member in Pasadena, California. “During the COVID-19 emergency, the office E/M level selection can be based on medical decision making (MDM) or time, as time is described for 2021,” he says.