jenlynn10013
New
Can I bill a telehealth visits (CPT 99441-99443) when just giving lab or sonogram results? If so, what would be the primary diagnosis code? Thank you.
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Wiki Telehealth Visits
- Thread starter jenlynn10013
- Start date
lgardner
Guest
99441 - 99443 are telephone visits not really telehealth (audio and video).
calling a pt with test results would not be a reason to bill these codes.
that is a routine phone call.
in order to bill for an E/M (even an audio only one), there has to be a Chief Complaint/reason for visit and some medical decision making.
giving a pt their results would not qualify.
I agree with most of @lgardner with a caveat. Yes, calling a patient and saying "your results were fine, I'll see you next year" does not qualify.
However, if the results needed to be discussed and a treatment plan developed, it is possible for test results to qualify as a visit (whether in person, audio/video, or audio only).
For any visit, the patient needs to consent to the visit. It can't be the provider called them and then wants to bill the service. For 99441-99443, they cannot be originating from a visit in the past 7 days, nor leading to a visit in the next 24 hours or soonest available.
Here are 3 clear examples:
1) Pt seen 10/15/2022 for well woman annual. PAP collected. Provider calls patient 10/25/2022 to say "PAP normal. See you next year." NOT A VISIT.
1) Pt seen 10/15/2022 complaining of urinary frequency. Provider orders urine culture. Provider calls patient 10/25/2022 to say "results were normal. Try some cranberry juice.", or even "Results showed a UTI and your prescription is at the pharmacy." NOT A VISIT
2) Pt seen 10/15/2022 complaining of pelvic pain and bloating. Provider orders sonogram which reveals a thickened lining and several large fibroids. Provider has nurse call patient to explain patient needs an appointment to discuss findings and treatment plan with the provider. Patient is unavailable to come in person (exposed to ebola, has a sick cat, whatever) and wants a telehealth, but doesn't have a device capable of audio/video so schedules a telehealth that will be audio only. Patient and provider speak on 10/25/2022 and provider explains findings, and that treatment options include repeat sonogram monitoring in 2 months, hysteroscopy D&C, and/or hysterectomy. They decide on hysteroscopy D&C. THAT IS A BILLABLE 99441-99443 even though technically it is a phone call to give the patient results.
Your diagnosis - whether in person or telehealth is whatever the problem is being treated. Example 3 above would be uterine fibroids and endometrial thickening.
I use this overall approach - the telemedicine coverage (whether audio/video or audio only) is intended to bill for visits that would typically take place in person, but for some reason are not. It is not intended to get payment for services you always provided without receiving direct payment for.
However, if the results needed to be discussed and a treatment plan developed, it is possible for test results to qualify as a visit (whether in person, audio/video, or audio only).
For any visit, the patient needs to consent to the visit. It can't be the provider called them and then wants to bill the service. For 99441-99443, they cannot be originating from a visit in the past 7 days, nor leading to a visit in the next 24 hours or soonest available.
Here are 3 clear examples:
1) Pt seen 10/15/2022 for well woman annual. PAP collected. Provider calls patient 10/25/2022 to say "PAP normal. See you next year." NOT A VISIT.
1) Pt seen 10/15/2022 complaining of urinary frequency. Provider orders urine culture. Provider calls patient 10/25/2022 to say "results were normal. Try some cranberry juice.", or even "Results showed a UTI and your prescription is at the pharmacy." NOT A VISIT
2) Pt seen 10/15/2022 complaining of pelvic pain and bloating. Provider orders sonogram which reveals a thickened lining and several large fibroids. Provider has nurse call patient to explain patient needs an appointment to discuss findings and treatment plan with the provider. Patient is unavailable to come in person (exposed to ebola, has a sick cat, whatever) and wants a telehealth, but doesn't have a device capable of audio/video so schedules a telehealth that will be audio only. Patient and provider speak on 10/25/2022 and provider explains findings, and that treatment options include repeat sonogram monitoring in 2 months, hysteroscopy D&C, and/or hysterectomy. They decide on hysteroscopy D&C. THAT IS A BILLABLE 99441-99443 even though technically it is a phone call to give the patient results.
Your diagnosis - whether in person or telehealth is whatever the problem is being treated. Example 3 above would be uterine fibroids and endometrial thickening.
I use this overall approach - the telemedicine coverage (whether audio/video or audio only) is intended to bill for visits that would typically take place in person, but for some reason are not. It is not intended to get payment for services you always provided without receiving direct payment for.
lgardner
Guest
great answer, Christine!
I agree 100% with your response.
I agree 100% with your response.