Primary Care Coding Alert

All the guideline changes and additions to the telehealth list you need to know.

On March 31, 2020, the Centers for Medicare & Medicaid Services (CMS) released an Interim Final Rule to consolidate, clarify, and add to the growing list of temporary changes to the current telehealth regulations (which we outline in a subsequent article in this issue) to enable physicians to offer safe and effective care during the current COVID-19 public health emergency (PHE).

This article outlines all the key telehealth developments that may well impact your primary care practice as accurately as possible. However, information related to the emergency changes rapidly, and CMS is frequently changing and clarifying the guidelines. For the most up-to-date information, go to authoritative sources such as CMS (cms.gov), CDC (cdc.gov), the AAPC blog (www.aapc.com/blog), and future issues of Primary Care Coding Alert.

Are We Going to Get Paid for Telehealth Services?

Yes. The Interim Final rule reiterated that Medicare expanded payment for telehealth services, “furnished by physicians and other practitioners to patients located anywhere in the country, including in a patient’s place of residence,” effective March 6. It also expanded the list of services for which Medicare will make separate payments and, in some instances, the circumstances under which Medicare will pay for other services, including telephone services such as 99441-99443 (Telephone evaluation and management service …) effective for dates of service on or after March 1, 2020. (Source: s3.amazonaws.com/public-inspection.federalregister.gov/2020-06990.pdf?utm_medium=email&utm_campaign=pi+subscription+mailing+list&utm_source=federalregister.gov).

Have Any Geographic and Technological Restrictions Been Lifted?

Yes. The Interim Final Rule states you can now furnish telehealth services to patients “wherever they are located, including in the patient’s home.” To do this, you should now use modifier 95 (Synchronous telemedicine service …) and “report the POS code that would have been reported had the service been furnished in person.” “This means, for example, using POS modifier 11 [Office] instead of 02 [Telehealth] to describe the point of service if the visit would normally have been conducted in the provider’s office,” Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana, suggests.

CMS has also revised its definition of “interactive telecommunications system” to include mobile phones for codes on the Medicare Telehealth Code List providing the communication is both aural and visual. For voice communications only with a physician or other qualified healthcare professional, you should use 99441-99443 or G2012 (Brief communication technology-based service, e.g. virtual check-in …).

The Department of Health and Human Services’ Office of Civil Rights is also waiving the HIPPA requirements that communications be encrypted. For the duration of the PHE, the final rule allows your provider to use “everyday communications technologies, such as FaceTime or Skype.”

How Will We Select E/M Levels Without Exams and Histories?

During the PHE, you may report 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) by either:

1) Using medical decision making (MDM) alone. This policy is “similar to the policy that will apply to all office/outpatient E/Ms beginning in 2021 under policies finalized in the CY 2020 PFS final rule,” according to the Interim Final Rule, though you must use the 2020 definition of MDM.

2) Using “all of the time associated with the E/M on the day of the encounter,” regardless of the current CPT^® E/M guideline to only use time “when counseling and/or coordination of care dominates (more than 50 percent) the encounter.” You should still use the “typical times” listed in the current 2020 CPT^® guidelines, according to the rule.

This means “you should ALWAYS record your time in case you need to use it to level the care,” Holle advises.

Are Telehealth Services Still Restricted to Established Patients?

CMS is expanding payment for many established patient services, including G2010 (Remote evaluation of recorded video and/or images …) and G2012. These services will also include new patients, even if the code descriptors will still say “established.” Additionally, for 99421-99423 and G2061-G2063, CMS will “relax enforcement … [and] not conduct review to consider whether those services were furnished to established patients.”

What About Patient Consent?

Telehealth consent may now be “obtained at the same time that a service is furnished” and be obtained by auxiliary staff under general supervision, not just by the billing practitioner, for the duration of the PHE.