Podiatry Coding & Billing Alert

Recognize Telephone E/M Codes

What are these services? These are telephone only E/M codes.

Which codes should you report for a telephone E/M service? Physicians or other qualified health care professionals who can report E/M services should report telephone E/M services with the following codes:

• 99441 (Telephone evaluation and management service by a physician… 5-10 minutes of medical discussion)
• 99442 (…11-20 minutes of medical discussion)
• 99443 (…21-30 minutes of medical discussion)

Qualified nonphysician health care professionals should report telephone E/Ms with telephone assessment and management codes 98966-98968.

Anything else I need to know about these codes?? Previous to the COVID-19 PHE, 99441-99443 and 98966-98968 were considered “noncovered,” but during an interim basis, CMS is establishing separate payment for these codes, per the Interim Final Rule.

“…in the context of the goal of reducing exposure risks associated with the PHE for the COVID-19 pandemic, especially in the case that two-way, audio and video technology required to furnish a Medicare telehealth service might not be available, we believe there are many circumstances where prolonged, audio-only communication between the practitioner and the patient could be clinically appropriate yet not fully replace a face-to-face visit,” per the Interim Final Rule. “We believe that the existing telephone E/M codes, in both description and valuation, are the best way to recognize the relative resource costs of these kinds of services. Therefore, we are finalizing, on an interim basis for the duration of the PHE for the COVID-19 pandemic, separate payment for CPT^® codes 98966-98968 and CPT^® codes 99441-99443.”

Don’t Forget These Monitoring Codes

What are the remote physiologic monitoring (RPM) codes? CMS allows for certain remote RPM codes. They are as follows:

• Collection and interpretation of physiologic data code 99091
• Remote monitoring of physiologic parameter(s) codes 99453 and 99454
• Remote physiologic monitoring treatment management services 99457 and +99458
• Self-measured blood pressure codes 99473 and 99474

What are the RPM codes used for? You report the RPM codes for “physiologic monitoring of patients with acute and/or chronic conditions,” according to the Interim Final Rule. Although the typical patient who needs an RPM service may have a chronic condition like high blood pressure or diabetes, you can also use RPM for other conditions like allowing a patient who has an acute respiratory virus to monitor his pulse and oxygen saturation levels using pulse oximetry, per the Interim Final Rule.

Puzzle Out These Telehealth Modifier Guidelines

What modifiers should I consider when reporting telehealth (audiovisual) services? You should consider the following four modifiers for telehealth (audiovisual) reporting:

• 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).

What is the important of Modifier 95? Medicare Part B requires the use of modifier 95 on telehealth claims during the extent of this COVID-19 PHE. Some commercial payers 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.

When would I use the other three modifiers? 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 telehealth service has been met.

Get Some Essential POS Background Knowledge

What it is a POS code for telehealth, and why is it important? The place of service (POS) code that you use for telehealth claims should be the place where the service would have been traditionally provided had it been a face-to-face visit. That’s because all telehealth services provided during the PHE are considered “nontraditional” telehealth services.

With a traditional telehealth service, Medicare pays the “originating site” the facility fee, leaving the provider with a reduced fee that takes out the overhead paid to the originating site. Since providers are still incurring overhead and there is no facility fee paid to an originating site, CMS has determined that the reduction in the fee schedule is not justified. This means that an office visit performed over telehealth under the PHE would be billed with a 95 modifier and POS of 11 (Office) for the office, even though the provider and patient may be communicating from their respective homes.

For telehealth claims that a provider would typically perform outside of the office, you’ll want to make sure to use the correct POS code for the respective location.

Don’t miss: You should not use POS 02 for Medicare Part B claims for any of the virtual services, including virtual check-ins and E-visits. You should check with commercial payers on how to proceed with POS codes for virtual check-ins and E-visits.

Disclaimer: Again, 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 Podiatry Coding and Billing Alert for more information. You can also refer to payer websites, CMS (cms.gov), CDC (cdc.gov), and AAPC’s blog (https://www.aapc.com/blog/) for the most up-to-date information.