Pediatric Coding Alert

Question: How can we know whether or not a code is eligible for use with telemedicine services?

Pennsylvania Subscriber

Answer: CPT^® 2017 features Appendix P, a new addition that helps coders decide which codes you can use when reporting telemedicine services.

Some of the codes in Appendix P include:

• 99201-99205,  Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components…
• 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components …
• 99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components …
• 99241-99245, Office consultation for a new or established patient, which requires these 3 key components …
• 99251-99255, Inpatient consultation for a new or established patient, which requires these 3 key components …
• 99307-99310, Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components …
• 99406 and 99407, Smoking and tobacco use cessation counseling visit …
• 99408 and 99409,  Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services …
• 99495 and 99496, Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period face-to-face visit …

Modifier alert: When you are reporting any of the Appendix P codes for telemedicine, you’ll need to make sure you know your payer’s preference concerning telemedicine modifiers. CPT^® has provided modifier 95 (Synchronous telemedicine service rendered via a real time interactive audio and video telecommunications system) for use on telemedicine services your physician provides.

For Medicare payers, and those that follow Medicare rules, you’ll append either modifier GT (Via interactive audio and video telecommunication systems) or GQ (Via asynchronous telecommunications system) to your Appendix P code to indicate a telemedicine encounter.

If you have any doubt as to your payer’s preference for telemedicine-related modifiers, be sure to call and check with a representative before filing the claim.