Pain Management Coding Alert

Question: Can we code for telemedicine services our physician or qualified nonphysician practitioner (NPP) provides? If so, should we use a specific code?

North Dakota Subscriber

Answer: It depends on what you mean by telemedicine. If you are referring to a phone call, most payers do not recognize codes 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) through 99443 (… 21-30 minutes of medical discussion).

If you are referring to online medical evaluations, there are several payers that will recognize 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network). Check with each payer to see its stance on 99444.

If you are referring to telemedicine visits where the patient is in a remote location and you’re conducting the visit with two-way video and audio communication, you’ll choose between G0425 (Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth) through G0427 (Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth) for Medicare payers and payers that follow Medicare.

Medicare designed these codes specifically for patients unable to make it to the office because of distance. You’ll use these codes mostly for usually initial office visits, emergency room services, or initial inpatient visits.

Remember: There are specific requirements concerning distances eligible for G0425-G0427 at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/telehealthsrvcsfctsht.pdf or https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6705.pdf.

Caveat: Practices are using telemedicine more commonly as technology advances — and many regulators are pushing for tighter telemedicine guidelines.

The American Medical Association (AMA) discussed the emergence of this technology and the new and innovative healthcare challenges that come from utilizing it, at its 2016 meeting in Chicago. The discourse centered on telemedicine and ethics with the proposition of guidelines to address this critical issue.

“Telehealth and telemedicine are another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions,” said AMA Board Member Jack Resneck, MD, at the annual meeting. “The new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians’ fundamental ethical responsibilities do not change.”

Resource: For the complete AMA news release about new telemedicine initiatives, visit: www.ama-assn.org/ama/pub/news/news/2016/2016-06-13-new-ethical-guidance-telemedicine.page.