Primary Care Coding Alert

Question: We heard that CMS introduced a new code for physician-to-patient Internet consultations. Is this true? Also, what are the requirements for reporting the code?

North Carolina Subscriber

Answer: Although Medicare hasn't introduced a code for Internet consultations, the government does offer payment guidelines for telehealth or telemedicine services. Generally, telehealth involves a physician consulting with a patient in another location by interactive video or television.

You may report telecommunications consultations (99241-99275), office visits (99201-99215), individual psychotherapy (90804-90809) and pharmacologic management (90862) as substitutes for a face-to-face or "hands-on" encounter, according to the Medicare Carriers Manual (MCM), section 15516.

But Medicare restricts telehealth coverage to facilities that are located in rural health professional shortage areas (HPSA), or have received an exemption to rural HPSA requirements. So if your family physician uses telehealth in an HPSA or HPSA-exempt hospital or critical-access hospital or at a rural health clinic or  federally qualified health center to treat a patient, you should report the appropriate E/M service or psychiatric therapeutic procedure.