Otolaryngology Coding Alert

If the news coming out surrounding virtual check-in coding has your head swirling, you’re in good company. That’s because the release of the 2021 Medicare Physician Fee Schedule (MPFS) final rule featured new coding guidance, and new codes, for audio virtual check-in services.

Specifically, you’ll want to home in on one specific HCPCS Level II code that the Centers for Medicare & Medicaid Services (CMS) has added to the mix in 2021. However, you’ll see that just because a new code is eligible for reporting doesn’t necessarily make it practical.

Get a glimpse at this new virtual check-in service code and consider some helpful coding guidance to ensure you’re maximizing your provider’s bottom line.

See What’s New With 2021 Virtual Check-in Coding

At the beginning of the public health emergency (PHE), you were introduced to all kinds of coding guidance on reporting for telehealth services, virtual check-ins, and e-visits. Despite the majority of attention being paid to telehealth coding, virtual check-ins have remained a constant and integral part of otolaryngology practice E/M services as the PHE persists into 2021.

Refresher: Technically, a virtual check-in includes any brief patient communication with a provider via a number of communication technology modalities. These may include telephone or asynchronous (staggered response) exchanges through video or image. This article focuses on synchronous audio exchanges, typically via telephone, that qualify as virtual check-in services.

While the concept is generally straightforward, the coding dynamics require some extra attentional to detail in order to ensure your provider is billing for the correct services and is compensated appropriately. With the release of the Medicare Physician Fee Schedule (MPFS) 2021 final rule, there’s been some added confusion surrounding what codes to report for Medicare Part B and other commercial payer virtual check-in services. The confusion began with the recent introduction of the following HCPCS Level II code:

• G2252 (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; 11-20 minutes of medical discussion)

As CMS puts it, this is essentially an indented code to G2012 (… 5-10 minutes of medical discussion) and is eligible for Medicare Part B (and other eligible commercial payer) reporting.

Consider Provider Eligibility for Some Virtual Check-in Codes

Your first point of order is to distinguish G2252 from the following two new virtual check-in codes, also released in 2021:

• G2250 (Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward…)
• G2251 (Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services… 5-10 minutes of clinical discussion)

These codes are designated to be reported by practitioners who cannot independently bill for E/M services. CMS refers to G2250 and G2251 as “sometimes therapy,” which may be billed by a private practice physical therapist (PT), occupational therapist (OT), or speech language pathologists (SLPs), among other nonphysician providers (NPPs). Alternatively, you will report G2010 (Remote evaluation of recorded video and/ or images submitted by an established patient (e.g., store and forward) …) for store and forward services by advanced practice providers (APPs) treating patients with Medicare Part B and other eligible payers.

Maximize Reimbursement With These Coding Adjustments

With the release of G2252, E/M coders are now scrambling to determine whether to report G2012 and G2252 in place of the following CPT^® codes for telephone-based E/M services, activated during the PHE for audio-only encounters with patients:

• 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)

You might recall in March of 2020 that CMS announced that it would temporarily extend coverage for 99441-99443 as virtual check-in service codes for the duration of the PHE. CMS explains in the 2021 MPFS final rule that 99441 and 99442 are direct crosswalks to G2012 and G2252, respectively. On top of that, CMS extending coverage to 99441-99443, and the respective fee schedules offering substantially more compensation than G2012 and G2252, the question begs: What circumstances, if any, should G2012 and G2252 be reported for eligible clinical virtual check-in services?

Fortunately, the answer is as straightforward as it seems while the PHE is ongoing. Until CMS announces coverage of 99441-99443 has ceased, you should be reporting it for all eligible (Medicare Part B and otherwise) telephone-based virtual check-in services. You’ll find that the fee schedule for 99441-99443 yields substantially more reimbursement than G2012 and G2252. Furthermore, CMS’ creation of a crosswalk between code sets does not mean that both codes sets will be reimbursed the same. Keep in mind that, on a longer timeline, the answer isn’t as straightforward until Congress makes a legislative decision on the future of telehealth.

Coder’s note: The 99441-99443 code description clearly indicates the known eight-day exclusion rule, in which the virtual check-in may not originate from a related E/M service within the prior seven days, nor may you report it when the check-in leads to an E/M service within the next 24 hours (or soonest available appointment thereafter). “However, keep in mind that there’s at least one Medicare Administrative Contractor, NGSMedicare, that has eliminated those exclusion days,” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, of CRN Healthcare in Tinton Falls, New Jersey. “Check with your local MAC to confirm that that the eight-day exclusion period still applies,” Cobuzzi advises.