Pulmonology Coding Alert

When to use POS 02 and modifiers GT, GQ, 95.

When your pulmonologist delivers approved telehealth services this year, you’ll have several key add-ons if you want to receive your pay for these claims.

Check Your Status

CMS is specific about who can bill telehealth, so you’ll need to ensure you’re eligible. “Not everyone qualifies as a telehealth provider,” says Carol Pohlig, BSN, RN, CPC, ACS,  senior coding and education specialist at the Hospital of the University of Pennsylvania. “Just because the codes are available for telehealth delivery, doesn’t mean that [all] providers can start billing for them.”

“Additionally, private payers may contract with specific providers to perform telehealth services. The rules for these payers may vary,” says Pohlig.

Resource: To learn more about telehealth and eligibility, visit https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/index.html.

Why POS 02 Matters

Eligible providers will use CMS’s new place of service (POS) code for telemedicine: POS 02 (Telehealth: The location where health services and health related services are provided or received, through a telecommunication system), according to an MLN Matters article released last August.

See www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9726.pdf to read the full article.

Be aware: Physicians working from a distant site who do not use POS 02 when reporting their telemedicine services started receiving denials as of Jan. 1 of this year.

Know the Differences: GT, GQ, and 95

In addition to adding POS 02, Medicare requires you to append either modifier GT (Via interactive audio and video telecommunication systems) or GQ (Via asynchronous telecommunications system) to your CPT^® or HCPCS code for telemedicine services.

Red flag: Medicare Administrative Contractor (MAC) will deny the service if you use the POS code 02 without the appropriate GT or GQ modifier, or vice versa.

For 2017, CPT^® has a new telemedicine modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) report telemedicine services your physician provides via real time, interactive audiovisual telecommunications.

Before you use modifier 95 or GT, check with your payer(s) to verify which is acceptable.

Codes You’ll Turn To

Here are some of the telehealth services codes that apply to your pulmonology practice, with a special focus on smoking cessation services, critical care, and advance care planning. “There are many ‘counseling’ based services that qualify for telehealth because the nature of the counseling does not lend to a particular method of delivery,” says Pohlig.

• 99201-99215, (Office or other outpatient visit…)
• 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes)
• 99407 (…; intensive, greater than 10 minutes)
• 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms [with completion of such forms, when performed], by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member[s], and/or surrogate)
• 99498 (…each additional 30 minutes [List separately in addition to code for primary procedure])
• G0508 (Telehealth consultation, critical care, initial, physicians typically spend 60 minutes communicating with the patient and providers via telehealth)
• G0509 (Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth)

Another resource: To see more on Medicare’s telemedicine service requirements, you can reference the 2017 Physician Fee Schedule Final Rule available under “RelatedLinks” at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1654-F.html.