Wiki billing for phone "visit"

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jenniferabdelnor

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With the increasing health scare of CoVid-19 we have many patients that do not want to come in to the office to be seen. Most of these are elderly patients and are not comfortable with video-chatting for a telehealth visit. They would like to just call and talk to their provider over the phone, most times needing Rx refills. Is there a code that we can use to bill for this other than 99441-99443?
Thanks for your help!
 
We are having the same issue/discussion at our office. Patients are calling and not wanting to come in due to CoVid-19. We do not have the option for video-chat at this time, but the providers are wanting to know if they can bill for telephone call with patient. Scenarios would be 1. patient calling needing a refill, but unwilling to come into the office, but needs to have a md "visit" prior to it being refilled. or 2. Patient with a new concern such as cough, etc and wanting to discuss with provider over the phone. I have read the CPT guidelines, and also reviewed several sites that say you can't use the 99441-99443 if the patient is at home. Is there a way to bill for the service our providers are giving? thanks so much!
 
Your providers are willing to deal with a cough over the phone???

We tell our patients "no." End.

By the way, you always have the option of making phone visits "cash only", but you still run the risk of malpractice issues by not seeing the patient in the flesh.
 
I still have not found a definite answer to the question: Patient with a new concern such as cough, etc and wanting to discuss with provider over the phone. Is there a way to bill for the service our providers are giving?
99441, 99442, or 99443 Telephone Non Face to Face
I found a document from CMS for Telephone check ins G2012.
Or Telemedicine 99213-GT? does this need an specific platform like video conference?
 
misstigris said:
We are having the same issue/discussion at our office. Patients are calling and not wanting to come in due to CoVid-19. We do not have the option for video-chat at this time, but the providers are wanting to know if they can bill for telephone call with patient. Scenarios would be 1. patient calling needing a refill, but unwilling to come into the office, but needs to have a md "visit" prior to it being refilled. or 2. Patient with a new concern such as cough, etc and wanting to discuss with provider over the phone. I have read the CPT guidelines, and also reviewed several sites that say you can't use the 99441-99443 if the patient is at home. Is there a way to bill for the service our providers are giving? thanks so much!
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I am not finding anything stating that you can't use 99441-99443 if patient is at home. Isn't that the point of the telephone service? Concerned that I am misinterpreting these codes. Any opinions?
 
GHSimson said:
I am not finding anything stating that you can't use 99441-99443 if patient is at home. Isn't that the point of the telephone service? Concerned that I am misinterpreting these codes. Any opinions?
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You can use those if the patient is at home, however, it is not for an appointment. It is for the times when the patient calls in between appointments with a problem and speaks to the provider. The details are in the intro to that section in the CPT book (and on my recent post on this subject).
 
Don't overlook G2012 for Medicare patients. This can be conducted by phone or video. The physician should document the patient's verbal consent for the service in addition to the context of the discussion.
G2012 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion

Also see the lessened restrictions announced for audiovisual telehealth services from CMS. The AAFP posted an article on it -https://www.aafp.org/journals/fpm/blogs/gettingpaid/entry/coronavirus_testing_telehealth.html.

Good luck and good health,
Cindy
 
With the Medicare Waiver being signed and put into effect on 3/6/2020 CMS will temporarily pay clinicians to provide telehealth services use codes 99211-15 as normal but change your Place of Service to 02 = telehealth and this is for telephone and does not require video. Commercial plans are different and some want 95 Modifier or GT.

MCR HAS NOW CHANGED THE POS TO 11 ADD MOD 95
 
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ldavis0202 said:
With the Medicare Waiver being signed and put into effect on 3/6/2020 CMS will temporarily pay clinicians to provide telehealth services use codes 99211-15 as normal but change your Place of Service to 02 = telehealth and this is for telephone and does not require video. Commercial plans are different and some want 95 Modifier or GT.
Click to expand...

I have not found anywhere this is stated. Everything I have found says Medicare still requires video.
 
jenniferabdelnor said:
With the increasing health scare of CoVid-19 we have many patients that do not want to come in to the office to be seen. Most of these are elderly patients and are not comfortable with video-chatting for a telehealth visit. They would like to just call and talk to their provider over the phone, most times needing Rx refills. Is there a code that we can use to bill for this other than 99441-99443?
Thanks for your help!
Click to expand...
Each payer has specific rules on telegraph visits some do not allow audio only visits
 
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Telehealth/ telemedicine visits sorry... and some require the use of specific modifiers etc... reach out to your payers for specifics or who handles the contracts on them!
 
Kathy Perry said:
I still have not found a definite answer to the question: Patient with a new concern such as cough, etc and wanting to discuss with provider over the phone. Is there a way to bill for the service our providers are giving?
99441, 99442, or 99443 Telephone Non Face to Face
I found a document from CMS for Telephone check ins G2012.
Or Telemedicine 99213-GT? does this need an specific platform like video conference?
Click to expand...
Most of our elderly are figuring out how to facetime or use our video visit withing EHR.
 
Use the codes as follows (during the COVID-19 emergency only):

G2012: brief telephone check-in (established only)
99441: telephone visit 5-10 min (new or established)
99442: telephone visit 11-20 min (new or established)
99443: telephone visit 21+ min (new or established)

G2010: brief asynchronous check-in (established only)
99421: asynchronous e-visit 5-10 min (new or established)
99422: asynchronous e-visit 11-20 min (new or established)
99423: asynchronous e-visit 21+ min (new ore established)

99201-99205 interactive telehealth visit new patient (with modifier 95, and commercial payers want POS 02)
99211-99215 interactive telehealth visit established patient (with modifier 95, and commercial payers want POS 02)
 
CatchTheWind said:
The rules about patient having to call from a health-care facility rather than their own home have been waived due to the crisis.
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can you tell me where you found that provider can get paid for phone call follow-up that the patient didn't initiate?
 
for telehealth visits that "are NOT related to an E/M service within the previous 7 days and do NOT lead to an E/M service within the next 24 hours or soonest available appointment."
What does that mean- for example: if provider has Virtual visits or Telephone E/M with patient that patient -initiated. Then, with Virtual Check-ins, provider is supposed to followup with patient within 24 hours. At that time, the patient reports additional symptoms and the provider determines that they need to do a more extensive visit (such as an office E/M code) via video telehealth does that count as next available appointment?

hope that questions makes sense.
 
lcohen4 said:
can you tell me where you found that provider can get paid for phone call follow-up that the patient didn't initiate?
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CatchTheWind didn't state a telephone call that the patient didn't initiate is billable. It was to reference the originating site requirement for telehealth. Prior to covid, telehealth was billable ONLY when the patient was located in an approved originating site, and not in their home. Currently, telehealth is billable if the patient is in their own home.
 
If you educate the patient that telehealth is available when they call or you call them to reschedule their appointment and they indicate they want to do via telehealth, that is patient initiation.

Betsy Rios, CPC, CMOM
Pro Fee/Pro Clinic Coding Mananger
HCCS HIM Services
www.hccscoding.com
info@hccscoding.com
 
jenniferabdelnor said:
With the increasing health scare of CoVid-19 we have many patients that do not want to come in to the office to be seen. Most of these are elderly patients and are not comfortable with video-chatting for a telehealth visit. They would like to just call and talk to their provider over the phone, most times needing Rx refills. Is there a code that we can use to bill for this other than 99441-99443?
Thanks for your help!
Click to expand...
To my understanding, these are the only codes available when a telephone visit is conducted.. You can always call the patient’s insurance company to get more information..
 
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Based on the recent CMS call dated 4/7/2020, phone calls still cant be billed with 99201-99215 unless it started out as a telemed visit and the video dropped, but the bulk of the encounter was telemed. If any one hears anything more current, please post. CMS is having weekly calls
 
BeverPrudh said:
Based on the recent CMS call dated 4/7/2020, phone calls still cant be billed with 99201-99215 unless it started out as a telemed visit and the video dropped, but the bulk of the encounter was telemed. If any one hears anything more current, please post. CMS is having weekly calls
Click to expand...

As an FYI for anyone else looking for this information, it's on page 11 of the COVID-19 Office Hours Call transcript for 4/7/20 :)
 
ldavis0202 said:
With the Medicare Waiver being signed and put into effect on 3/6/2020 CMS will temporarily pay clinicians to provide telehealth services use codes 99211-15 as normal but change your Place of Service to 02 = telehealth and this is for telephone and does not require video. Commercial plans are different and some want 95 Modifier or GT.

MCR HAS NOW CHANGED THE POS TO 11 ADD MOD 95
Click to expand...
Can you please explain what do you mean by 99211-15 as normal but change your POS to 02=telehealth and this is for telephone?
 
jdawes4 said:
Can you please explain what do you mean by 99211-15 as normal but change your POS to 02=telehealth and this is for telephone?
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Use your normal e/m code 99211 99212 99213 etc... the (POS) place of service was 02 but Medicare changed it April 3rd to 11 office setting place of service with a 95 modifier and this is for audio only
 
jhendrix08 said:
During the pandemic, Medicare is not requiring video only visits. They are allowing providers to bill for telephone calls in the case where a patient doesn't have access to FaceTime/Skype or any other video platform. I have attached a link that may be helpful.
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That is AMA info, not Medicare info. And you even said, "allowing to bill for telephone calls" - I'm not saying they couldn't bill for phone calls, I'm saying they can't bill them as an office visit instead of as a phone call, AND I'm looking for official documentation saying otherwise.

Medicare info is here. From there Page 36, item 4:

Question: Can practitioners provide Medicare telehealth services using their phones?
Answer: Yes, for use of certain phones. Section 1135(b)(8) of the Social Security Act allows the Secretary to authorize use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 PHE. Additionally, CMS amended its regulations through the IFC to remove the potential perception of restrictions on technology that practitioners can use to provide telehealth services. The Office of Civil Rights has also issued guidance allowing covered health care providers to use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk of penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.

So I ask again, please show me where Medicare states that you can bill a telehealth OFFICE visit that does not include video, unless you are billing a phone call code instead of an office visit code. I'm not trying to argue, I'm trying to get someone to give me the official information.
 
Anything I have seen from CMS leads me to agree with Sharon on this.
Historically, Medicare never covered telephone (only G2012). Medicare is now covering telephone.
Many people made the leap in their heads equating Medicare covering telephone is the same as Medicare telephone should be coded as E/M.
I will note that there are private carriers that have officially stated telephone should be billed E/M. I have not seen anything from CMS or any Medicare carrier stating the same. I have read many, many documents from CMS and/or Medicare carriers stating telephone should be 99441-99443 and is now covered.
 
csperoni said:
Anything I have seen from CMS leads me to agree with Sharon on this.
Historically, Medicare never covered telephone (only G2012). Medicare is now covering telephone.
Many people made the leap in their heads equating Medicare covering telephone is the same as Medicare telephone should be coded as E/M.
I will note that there are private carriers that have officially stated telephone should be billed E/M. I have not seen anything from CMS or any Medicare carrier stating the same. I have read many, many documents from CMS and/or Medicare carriers stating telephone should be 99441-99443 and is now covered.
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Maybe I misunderstood Sharon's initial question & point. Yes, I agree with you Christine. CMS and/or Medicare are stating that telephone visits should be billed using 99441-99443, not an in office face to face E/M code. We're on the same page.
This is new to all of us and I've always found this platform to be extremely helpful. Hopefully it continues to be a positive place to ask for guidance and learn from others in the same profession.
 
jhendrix08 said:
This is new to all of us and I've always found this platform to be extremely helpful. Hopefully it continues to be a positive place to ask for guidance and learn from others in the same profession.
Click to expand...

Oh heavens, yes! It's easy to get bogged down into thinking we're talking about the same thing, and then us (okay, ME) noticing one word that I think we're assuming means the same thing and it doesn't necessarily mean the same thing. ;)

Sharon
 
I'm still so confused ..so I'm seeing that commercial payers are allowing e/m codes without audio/video, but we are not seeing anything from CMS for Medicare allowing e/m without video?
 
CatchTheWind said:
Use the codes as follows (during the COVID-19 emergency only):

G2012: brief telephone check-in (established only)
99441: telephone visit 5-10 min (new or established)
99442: telephone visit 11-20 min (new or established)
99443: telephone visit 21+ min (new or established)

G2010: brief asynchronous check-in (established only)
99421: asynchronous e-visit 5-10 min (new or established)
99422: asynchronous e-visit 11-20 min (new or established)
99423: asynchronous e-visit 21+ min (new ore established)

99201-99205 interactive telehealth visit new patient (with modifier 95, and commercial payers want POS 02)
99211-99215 interactive telehealth visit established patient (with modifier 95, and commercial payers want POS 02)
Click to expand...
E&M Telehealth visits are billed with the POS and E&M codes (with modifier 95, Cigna has been using GQ) as if the patient came into the office. Only BCBS wants POS of 2. These visits can be billed even if it was audio only; audio only is not the same as a virtual check in. Virtual check in would be used if there was a brief phone call to decide if an office visit or other service is needed. If an office visit even via telehealth is not required then bill using the codes G2012, G0210, if an office visit is needed bill appropriately. Also codes 99421-99423 is accumulated time over a 7 day period. The best article I have found is MLN # SE20011 released 4/10/20.
CatchTheWind said:
Use the codes as follows (during the COVID-19 emergency only):

G2012: brief telephone check-in (established only)
99441: telephone visit 5-10 min (new or established)
99442: telephone visit 11-20 min (new or established)
99443: telephone visit 21+ min (new or established)

G2010: brief asynchronous check-in (established only)
99421: asynchronous e-visit 5-10 min (new or established)
99422: asynchronous e-visit 11-20 min (new or established)
99423: asynchronous e-visit 21+ min (new ore established)

99201-99205 interactive telehealth visit new patient (with modifier 95, and commercial payers want POS 02)
99211-99215 interactive telehealth visit established patient (with modifier 95, and commercial payers want POS 02)
Click to expand...
E&M Telehealth visits are billed with the POS and E&M code(s) (modifier 95, Cigna has been using GQ) equal to what it would have been had the service been furnished in person. Only BCBS wants POS of 2. These visits can be billed even if it was audio only; audio only is not the same as a virtual check in. Virtual check in would be used if there was a brief phone call to decide if an office visit or other service is needed. If an office visit even via telehealth is not required then bill using the codes G2012, G0210, if an office visit is needed bill appropriately. Also codes 99421-99423 is accumulated time over a 7 day period. The best article I have found is MLN # SE20011 released 4/10/20.
 
All CMS guidance I have seen only allows the telephone codes 99441-99443 or G2012 to be used for audio only. Medicare requires realtime interactive video to use E/M codes.
Private carriers may have different policies on this. SOME are permitting E/M for audio only. Some are not and require 99441-99443 or G2012. Some are vague. Medicare is clear. Audio only is telephone, and there are codes 99441-99443 that Medicare historically did not cover, but will now cover. They even upped their reimbursement so that 99441-99443 are paying basically the same as E/M.
You should not bill E/M for audio only unless you have a policy in writing from the carrier stating to do so. As of right now, there has not been any such policy from Medicare.
 
Notice from the newsroom press release from CMS.gov announcing the relaxation of the requirement for telehealth services to be audio/visual to allow audio only. Also expanding the covered Telehealth services. The guidance specifically states;

"Since some Medicare beneficiaries don’t have access to interactive audio-video technology that is required for Medicare telehealth services, or choose not to use it even if offered by their practitioner, CMS is waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services. "

A Link to this article and to the Medicare Telehealth Services is below.




I believe this explicitly states that 99211-99215 can be administered via telehealth or via audio only for those who cannot or do not choose to use telehealth platforms. All I have seen so far is an absence of guidance so if there is written guidance which invalidates this, please let me know.
 
briansmith99 said:
Notice from the newsroom press release from CMS.gov announcing the relaxation of the requirement for telehealth services to be audio/visual to allow audio only. Also expanding the covered Telehealth services. The guidance specifically states;

"Since some Medicare beneficiaries don’t have access to interactive audio-video technology that is required for Medicare telehealth services, or choose not to use it even if offered by their practitioner, CMS is waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services. "

A Link to this article and to the Medicare Telehealth Services is below.




I believe this explicitly states that 99211-99215 can be administered via telehealth or via audio only for those who cannot or do not choose to use telehealth platforms. All I have seen so far is an absence of guidance so if there is written guidance which invalidates this, please let me know.
Click to expand...

I do not make that leap from Medicare beneficiaries are now covered for telephone evaluation and management services to bill those services with 99201-99215.
I still have not seen any CMS or Medicare guidance advising to bill audio only as 99201-99215. The links you provide state audio only is covered, but does not state to bill them 99201-99215. I have read several documents advising audio only is now covered, and the codes for that are 99441-99443.
https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Section L, questions 15, 24 & 31 all specify to use 99441-99443 for audio only.
https://www.ngsmedicare.com click on prominent COVID 19 banner, then Telehealth Services on left:
Telephone Evaluation and Management Visits
The March 30 Interim Final Rule with Comment Period added coverage during the Public Health Emergency for audio-only telephone evaluation and management visits (CPT codes 99441, 99442 and 99443) retroactive to 3/1/2020. On 4/30/2020, a new Physician Fee Schedule was implemented increasing the payment rate for these codes. MACs will reprocess claims for those services that they previously denied and/or paid at the lower rate.

There are also a number of add on services (CPT codes 90785, 90833, 90836, 90838, 96160, 96161, 99354, 99355, and G0506) which Medicare may have denied during this Public Health Emergency. MACs will reprocess those claims for dates of service on or after 3/1/2020.

CMS even posted a YouTube MLN
. At 4:57, 11:14, 17:15 and especially 19:00, it is specified that audio only is covered with telephone evaluation & management, and should be billed 99441-99443.

I will note there are some counseling codes that typically require video that Medicare has waived and may be provided via audio only. I am not familiar with the nuances of this waiver as this is not a service we provide in my practice. I believe CMS has been clear with this. Audio only is covered with 99441-99443 for clinicians who may independently bill.
 
csperoni said:
All CMS guidance I have seen only allows the telephone codes 99441-99443 or G2012 to be used for audio only. Medicare requires realtime interactive video to use E/M codes.
Private carriers may have different policies on this. SOME are permitting E/M for audio only. Some are not and require 99441-99443 or G2012. Some are vague. Medicare is clear. Audio only is telephone, and there are codes 99441-99443 that Medicare historically did not cover, but will now cover. They even upped their reimbursement so that 99441-99443 are paying basically the same as E/M.
You should not bill E/M for audio only unless you have a policy in writing from the carrier stating to do so. As of right now, there has not been any such policy from Medicare.
Click to expand...

Are they still requiring a modifier for 99441-99443? I keep seeing a modifer isn't needed.
 
Has anyone confirmed guidelines from CMS for telehealth phone visits conducted within the same week as being billable or not billable? Example: 99442 on 4/6/2020 and again on 4/8 and again on 4/10? Can we bill a 99442 on all three visits? Or are we only allowed to bill the first visit as the other two are within 7 days?
 
The lastest guideline (06/16/2020) from my MAC, NGS is that telephone may be billed as often as needed.
Changes in Guidance for E/M Telephone Services (99441-99443)
We are informing providers of a recent revision in interpretation and guidance for use of CPT codes 99441-99443 for telephone E/M services.

Since these telephone services have been designated by CMS as representative of E/M services for patients who do not have the capability for telehealth visualization, the only associated frequency limit is the long standing rule of no more than one service being billable per day. When repeated services are medically necessary, for patient follow up or care for a new problem, these services may be performed as frequently as is necessary for the patients care and safety.
 
Does anyone know if a telephone visit can be billed in the "hospital inpatient setting"? I have a pt whom had a face to face initial visit/consult by my specialty/group and then the following day, a different provider in the same specialty group, performed a telephone visit because the pts covid test result was not back yet and the provider did not want to risk exposure. The patient was not seen again by this specialty/group until 3 days later and on that day and each day after they performed face to face visits because the test result was negative. Is that subsequent inpatient visit via telephone billable, and if so - how?
 
I think you asked this in another post, which I just answered. In your scenario, you stated the provider was at the hospital, just not in the patient's room. That does not qualify for telehealth as the patient and provider are at the same location (just different rooms). Per CMS, it should be billed as usual.
9. Question: Should on-site visits conducted via video or through a window in the clinic suite be reported as telehealth services? How could a physician or practitioner bill if this were telehealth? Answer: Services should only be reported as telehealth services when the individual physician or practitioner furnishing the service is not at the same location as the beneficiary. If the physician or practitioner furnished the service from a place other than where the beneficiary is located (a “distant site”), they should report those services as telehealth services. If the beneficiary and the physician or practitioner furnishing the service are in the same institutional setting but are utilizing telecommunications technology to furnish the service due to exposure risks, the practitioner would not need to report this service as telehealth and should instead report whatever code described the inperson service furnished. New: 4/9/20
from page 61 https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
 
Hello everyone - This post is very helpful for many of us trying to figure out all these changes.

I just want to make sure I'm understanding this correctly on Telephone CPT codes.

Telephone 99441-43:
- part of the telemedicine
- POS 11

if patient calls and is scheduled as telemedicine and the provider speaks with a patient for 11minutes and does a full report (HPI, exam (self exam), MDM) we can bill it as 99441-43 ???
 
My understanding of the telephone codes is that they are billed only based on time. 11 minutes is 99442.

History, exam & MDM apply to leveling E/M 99201-99215. Please note currently the telehealth via audio/VIDEO may be leveled by either MDM only or time.
 
REIMBURSEMENT due to Covid - Is reimbursement for Telephone close to reimbursement for same level Telemed visits ? I know Yes to CMS what about other carriers ?
 
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