Wiki Online/E visits

[ny@fhcjoplin.com]

Hi

Has anyone had success billing for e visits? The cpt code for it is 99444. We are looking to include this in the practice but don't know if the commercial payers pay for it or if there is a better way to bill it.

I see that medicare has a modifier for it, GQ and says to bill the regular office visit, 99201-214 and then put the modifier after it.

Any help or suggestions would be SO appreciated.

Thanks.
Ny

 

[mitchellde]

modifier GQ is not used for e-mail it is used for telehealth services which is defined as: interactive audio and video communications must be used to permit real-time communication between the distant site physician/practitioner and the Medicare beneficiary. The patient must be present and participating in the telehealth visit.
online visits can only be coded with 99444 and must be initiated by the patient.

 

[ny@fhcjoplin.com]

but...

The medicare modifier GQ says "via asynchronous telecommunications system."

This doesn't say tele health, which has a very particular definition I've discovered.

Modifier GT says "via interactive audio and video telecommunications systems" this seems to be the one for the tele health.

And the new 99444 doesn't describe whether the encounter is patient or doctor initiated. And it is different from the 99441 tele health code. The only stipulation I see on it is that it can only be reported once every 7 days. Which they define telecommunications system as non face to face evaluation using internet resources in response to a patient's on line inquiry.

How do I determine? I've talked to our insurance reps about it, and they are clueless.

Should I just try a medicare one and a regular commercial one? We use our patient portal which is secure for this type of communication anyway, dr to pt, etc. I am just trying to determine if we can bill for it. Our providers are also wanting to use some sort of virtual visit type thing. I see that a number of the major payers are establishing their own "virtual visits"

Thanks!

 

[mitchellde]

when it says"in response to a patient's on line inquiry" this means the patient must initiate the email. Here is what the med leran matters said about the use of GQ and GT
In addition, effective January 1, 2008, the
following modifiers are valid when billed
with HCPCS code 96116:

GT Via interactive audio and video telecommunications system
GQ Via asynchronous telecommunications system
The expansion to the list of Medicare
telehealth services does not change the
eligibility criteria, conditions of payment, or payment or
billing methodology applicable to Medicare telehealth services as set forth in the Medicare Benefit
Policy Manual (Publication 100-02, Chapter 15, Section 270) and the MedicareClaims Processing Manual (Publication 100-04, Chapter 12, Section 190).
For example, originating sites must
be located in either a non- Metropolitan Statistical Area (non-MSA) county or rural Health
Professional Shortage Area (HPSA) and must be one of the following:
•Physician’s or practitioner’s office,
•Hospital,
•Critical access hospital (CAH),
•Rural health clinic, or
•Federally qualified health center.
Also, an interactive audio and video telecommunications system must be used
permitting real-time communication between the distant site physician orpractitioner and the Medicare beneficiary, and as a condition of payment, thepatient must be presentand participating in the telehealth visit. The onlyexception to the interactive telecommunications requirement is in the case of
Federal telemedicine demonstration programs conducted in Alaska or Hawaii. In this circumstance, Medicare payment is permitted for telehealth services when asynchronous store and forward technology is used.
Effective January 1, 2008,
CR 5628 instructs that:
•Your local part B Carriers and or
A/B MACs will pay for HCPCS code
96116 according to the appropriate physician or practitioner fee schedule
amount when submitted with a GT or GQ modifier, and
•Your local FIs and or A/B MACs
will pay for HCPCS code 96116 when
submitted with a GT or GQ modifier
, by CAHs that have elected Method II
payment on Type of Bill (TOB) 85x.