Wiki Telemedicine- HELP

[Shelli Morris]

We are a family practice and our physician would like to start billing telemedicine for those calls he gets over the weekend or after hours for simple problem solving diagnosis'. IE: sinus infections, rash etc.. Are there any special video or reporting devices that we need in the office to bill these services to insurances? I know that not all carriers will allow but he is insistent that he can be paid for these calls. We were looking at billing 99441- 99443 with the proper documentation of the call of course. Is there anything else we need? Any help would be greatly appreciated.
Thanks-
new to the coding world.....

 

[pscanlan]

No particular equipment is required for those codes, just a documented note in the chart detailing the specifics of the call. These codes specifically refer to "Non-Face-to-Face Services" with a subheading Telephone Services.

Two rules of thumb:
1. Patient cannot have been seen in office in the prior 7 days for the call to be billable.
2. If the call results in an immediate recommendation of a new appointment, hospitalization or other significant service within 24 hours of the call, it is not billable.

Hope this helps.

Edit: Since you've said you're new to the coding world, remember that if you file to insurance, in most cases you are legally obligated to bill the patient for any remaining balance. That may or may not be something your physician wants to do, but if he's filing to insurance he has to make good faith attempts to collect copays and deductibles from the patient. You cannot file to insurance and then simply write off the patient balance - this is insurance fraud. I know physicians get antsy about billing their patients, and this service (a phone call) would be the kind of service that would most likely get the write off treatment. Just a fair warning before you get audited for suddenly billing 500 telephone calls that you didn't bill at all last year.

 

[Shelli Morris]

thank you

Thanks so much! This is very helpful.