Wiki Telemed visit while patient in hospital

[DianeErbele]

One of our dermatologists had a telemed visit with a patient who was in the hospital for an unrelated condition. I used modifier 95 on the E&M code. Medicare denied it saying only that there is "another modifier or code" that I should be using. I can't find what this should be though. Can someone help me? Thank you!

 

[SharonCollachi]

What insurance, what pos code, what cpt code?

 

[DianeErbele]

Medicare, POS is 11 and 99213

 

[lcolborn]

GT modifier for Medicare . I'm not clear on the place of service though on the initial question..., is this an inpatient or outpatient visit ?

 

[csperoni]

If the patient was inpatient hospital, wouldn't you use 99221-99233? And POS for telemed is whatever the POS would be if it were an in person visit, so 21 in this situation. And I believe Medicare does currently accept -95 for telehealth during the public health emergency. I know it's confusing with the rules changing several times. Hope this helps!

 

[DianeErbele]

GT modifier for Medicare . I'm not clear on the place of service though on the initial question..., is this an inpatient or outpatient visit ?

The patient was an inpatient at a hospital for something unrelated to dermatology. One of our dermatologists had a telemed visit with him while patient was in the hospital (dermatologist was in our clinic). I used a 95 modifier but Medicare denied the charge. E&M was 99213. I thought I read that GT modifier was not appropriate in a situation like this.

 

[DianeErbele]

GT modifier for Medicare . I'm not clear on the place of service though on the initial question..., is this an inpatient or outpatient visit ?

Patient was inpatient at a hospital for something unrelated to dermatology. One of our dermatologists who was in our clinic had a telemed visit with the patient while patient was in the hospital. I used 99213 and modifier 95 and Medicare denied it.

 

[SharonCollachi]

The modifier is not the problem, it's the CPT code. 99213 is an outpatient code and your patient was inpatient. Look at 99231-99233.

 

[DianeErbele]

The modifier is not the problem, it's the CPT code. 99213 is an outpatient code and your patient was inpatient. Look at 99231-99233.

Okay. Thank you!!

 

[DianeErbele]

The modifier is not the problem, it's the CPT code. 99213 is an outpatient code and your patient was inpatient. Look at 99231-99233.

So I would still use the 95 modifier because it was a telemed visit, correct?

 

[DianeErbele]

If the patient was inpatient hospital, wouldn't you use 99221-99233? And POS for telemed is whatever the POS would be if it were an in person visit, so 21 in this situation. And I believe Medicare does currently accept -95 for telehealth during the public health emergency. I know it's confusing with the rules changing several times. Hope this helps!

Thanks for your reply. I will use an inpatient E&M code.

 

[DianeErbele]

Okay. Thank you!!

Can you tell me the difference between an initial and subsequent hospital care E&M code? I've researched this and not finding what I need. I'm wondering if I use an initial or subsequent code. Thanks so much!

 

[SharonCollachi]

Some insurances will only allow the admitting provider to use the initial code. Others will allow anyone to use that code for the first hospital visit by that provider.

 

[csperoni]

Yup - what Sharon said. Medicare will allow any provider to use the initial code since they have done away with consult codes. From what I've seen, most carriers follow that same rule.

 

[DianeErbele]

Yup - what Sharon said. Medicare will allow any provider to use the initial code since they have done away with consult codes. From what I've seen, most carriers follow that same rule.

Thank you! This is helpful.

 

[DianeErbele]

Some insurances will only allow the admitting provider to use the initial code. Others will allow anyone to use that code for the first hospital visit by that provider.

Thanks so much!

 

[misstigris]

Can I ask a follow up question to this? I have a similar scenario. Medicare inpatient at hospital. Had a phone call appt (no video) with our provider (located in office). Death with Dignity discussion due to hospital inpatient diagnosis. Can my provider bill for this? CPT code, POS, modifier? Thanks in advance!

 

[lbortzfield]

Can I ask a follow up question to this? I have a similar scenario. Medicare inpatient at hospital. Had a phone call appt (no video) with our provider (located in office). Death with Dignity discussion due to hospital inpatient diagnosis. Can my provider bill for this? CPT code, POS, modifier? Thanks in advance!

If it was Audio only then the CPT would be 99441-99443, no modifier and POS 11 for Medicare

 

[csperoni]

If it was Audio only then the CPT would be 99441-99443, no modifier and POS 11 for Medicare

If the patient was inpatient at hospital, wouldn't the POS be 21? I know definitely for telehealth (video/audio) it is the POS that it would have been if not for the PHE. I understood the same to apply to telephone and modifier 95. https://codingintel.com/payment-for-phone-calls-cms-update/

 

[Melibrooke418]

One of our therapists had a telemed visit with a patient who was in the SNF for anxiety disorder. The billing company put modifier 95 on the E&M code with 90837 Medicare denied it saying that Medicare part A denies the claim since patient is in a SNF, can we submit a corrected claim? Can someone help me? Thank you!