Primary Care Coding Alert

Learn how to remain HIPAA compliant.

If you’re like most coders, you’ve probably had a never-ending stream of telehealth questions during the COVID-19 public health emergency (PHE). So, if you’re looking for help navigating the Centers for Medicare & Medicaid Services’ (CMS’) most up-to-date regulations, you’ve come to the right place.

Whether you’ve been leaning on telehealth, or are just starting to get into it, keep reading to find out what you can expect as the PHE continues and once it ends.

Expect the Addition of Some Services, an Extension of Others

According to the CMS MPFS final rule, several emotional/ behavior assessments as well as psychological, and neuropsychological testing and evaluation services have been added to the Medicare Telehealth List on a Category 3 (temporary) basis (see www.cms.gov/medicare/medicare-general-information/telehealth/telehealth-codes). Those will be on the list through the end of 2023 or 151 days after the PHE ends, whichever is later.

Additionally, CMS finalized the following codes on a Category 1 (permanent) basis:

• G0316 (Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service …)
• G0317 (Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service…)
• G0318 (Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service…)
• G3002 (Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool…)
• G3003 (Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month…)

Modifier alert: To identify services as Medicare telehealth, CMS is requiring you to append modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) to the claim.

Prepare for Place-of-Service Codes

Under the final rule for 2023, CMS is continuing to let providers bill for place of service (POS) as if the provider furnished the service in person, which would typically be the office. This means you do not need to use POS 02 (Telehealth provided Other than in patient’s home) or POS 10 (Telehealth provided in patient’s home) at this time; instead, you may use a code such as POS 11 (Office) if that is where your provider would have normally performed the service in person.

Note: Though beneficiaries are not limited to qualifying ZIP codes or locations, such as facilities or physician offices, you should still be mindful of where the provider rendering the services is located. Local state restrictions for rendering medical care across state lines and practice scope limitations, along with payer rules and requirements, may limit your ability to bill out-of-state patients for telehealth services. You can begin your research to find out if your practice is compliant with the current telehealth guidelines by going to https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/telehealth-licensing-requirements-and-interstate-compacts/.

Post-PHE: The final rule stipulates that when the PHE ends, providers will need to adapt to a post-COVID coding landscape. Starting on the 152nd day after the PHE concludes, providers will need to indicate the appropriate POS code, the agency says. CMS finalized these options for continued use after the PHE:

• POS 02 (Telehealth provided other than in patient’s home)
• POS 10 (Telehealth provided in patient’s home)

Understand Audio-Only Interaction

Currently, providers can offer “certain counseling behavioral health care and educational services” as audio-only, such as 99497/+99498 (Advance care planning… first 30 minutes/each additional 30 minutes…) and G0438/G0439 (Annual wellness visit… initial visit/subsequent visit), according to CMS.

Also, your practice can offer 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services …; 5-10 minutes of medical discussion), 99442 (… 11-20 minutes of medical discussion), or 99443 (… 21-30 minutes of medical discussion) as telephone/audio-only services if they are conducted by physicians or other qualified healthcare professionals (QHPs), as the descriptor states. Medicare coverage of 99441-99443 expires with the PHE plus 151 days.

Remember: Physicians and QHPs must meet and follow current CPT^® guidelines for the services. Again, you should consult the Medicare telehealth services list for the current status of services that providers can render as audio-only.

Modifier alert: For qualifying audio-only services, you can select either Medicare modifier FQ (The service was furnished using audio-only communication technology) or CPT^® modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system). Modifier FR (The supervising practitioner was present through two-way, audio/video communication technology) is also still available for use on applicable claims.

Post-PHE: “Following the 151-day post-PHE extension period, CMS will once again assign the telephone E/M services a ‘bundled’ status, which means Medicare will no longer separately pay for them,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Know How to Stay HIPAA Compliant During Sessions

During the PHE, CMS is allowing providers to use “popular non-public facing applications that allow for video chats … without risk of penalty for noncompliance with the HIPAA Rules.” This means providers and patients can currently use such popular audio/video platforms as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype” for “all services on the Medicare telehealth list,” according to an FAQ published by CMS (www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf, page 74).

Keep an Eye Out for Updates on End Dates

Currently, the COVID-19 PHE has been extended until January 11, 2023 (see https://aspr.hhs.gov/legal/PHE/Pages/covid19-13Oct2022.aspx). But in a letter to state governors, the Biden administration indicated “when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination” of the PHE end date. This means, “at present, if the PHE expires on Jan. 11, 2023, the availability of telehealth and the rules applicable during the PHE will extend 151 days after the PHE end date. At this point, that would be June 11, 2023, far into the second quarter of 2023,” notes Leah Fuller, CPC, COC, senior consultant, Pinnacle Enterprise Risk Consulting Services, in Charlotte, North Carolina.