Otolaryngology Coding Alert

Question: If a visit starts as telehealth and the patient then comes to the office for an exam, does the service still remain as telehealth, or does it change it to an office visit and we just remove the telehealth modifier?

California Subscriber

Answer: For 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 seven 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.

So, the work involved in the telehealth visit is incorporated into the separately reported 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/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.

Of note, NGS Medicare has stated that they have waived the seven-day period that brackets audio visits as long as the subsequent encounter is medically necessary.

But if the telehealth visit was performed via audio/video technology, and therefore the service was coded 99201-99215, there is no limitation on subsequent encounters that the patient has with the provider. So, if the patient has an encounter the next day, both the E/M for the telehealth audio/video encounter and the E/M for the in-person encounter the next day can be coded as long as the note supports medical necessity for both services.