Wiki TELEMEDICINE VS. PHONE APPT

[bill2doc]

Hi All,

Are any of you billing for telemedicine? If so, can you share what we need to know? CPT codes used? Does telemedicine mean on a video device vs. phone appt which is on the phone? Any clarification would be appreciated!!

 

[dtricia]

Telemedicine includes video/Zoom and telephone (99441-99443). a phone visit should have a time statement, either start/stop or total time spent.
The virtual visit/Zoom will be billed with regular E/M codes with a 95 modifier.
The type of visit is determined when appt is made-Telephone or Virtual. The guidelines for billing vary extensively per payor. Some want you to crosswalk your telephone visit to regular E/M with modifier during the pandemic, some don't.

 

[DIM16]

Telemedicine includes video/Zoom and telephone (99441-99443). a phone visit should have a time statement, either start/stop or total time spent.
The virtual visit/Zoom will be billed with regular E/M codes with a 95 modifier.
The type of visit is determined when appt is made-Telephone or Virtual. The guidelines for billing vary extensively per payor. Some want you to crosswalk your telephone visit to regular E/M with modifier during the pandemic, some don't.

Could we use prolonged services code G2212 or 99417 with 99441 - 99443?

 

[jmph0916]

Could we use prolonged services code G2212 or 99417 with 99441 - 99443?

You cannot bill prolonged services on telephone visits, for video (telehealth) you may depending on the payor and how they want the claim billed. Each payor has a policy on how to bill both telephone and telehealth visits including POS and modifiers needed for billing. We created a spreadsheet for the payors we bill and the dates they changed policies to make it easier for us.

 

[DIM16]

You cannot bill prolonged services on telephone visits, for video (telehealth) you may depending on the payor and how they want the claim billed. Each payor has a policy on how to bill both telephone and telehealth visits including POS and modifiers needed for billing. We created a spreadsheet for the payors we bill and the dates they changed policies to make it easier for us.

I came across 99354 and 99355 as an addition code, if required for 99441-99443 telephone visit codes.

 

[thomas7331]

I came across 99354 and 99355 as an addition code, if required for 99441-99443 telephone visit codes.

This is incorrect - per the 'code first' note in CPT, these codes may only be used in addition to 99241-99245, 99324-99337, 99341-99350, 90837, 90847.

I agree with the post above that you cannot bill prolonged time for the telephone service codes, unless a payer has a policy specifically allowing it.

 

[csperoni]

Telephone 99441-99443 do not have prolonged service codes, per the correct responses by @jmph0916 and @thomas7331.

From CMS FAQs, section P, question 32:
Question: How should practitioners bill for audio-only services that last longer than 30 minutes?
Answer: During the PHE for the COVID-19 pandemic, Medicare has added to the list of telehealth services CPT codes 99441–99443, which describe audio-only phone visits with practitioners who can independently bill for E/M services, and CPT codes 98966–98968, which describe audio-only phone visits with practitioners who cannot independently bill for E/M services (for example certain therapists, social workers, and clinical psychologists). CPT codes 99443 and 98968 describe 21–30 minutes of medical discussion, respectively for each practitioner type; but there are no CPT codes available to describe medical discussions lasting longer than 30 minutes.
New: 5/27/2020

It is possible a commercial carrier has set a different policy, but I have not seen any.