On-Line Digital Evaluation & Management Services: Updated information on Telemedicine

Providers who have patients that cannot make appointments due to need for isolation, quarantine, or social distancing may still need your management and when done as an online evaluation or phone call there are three code sets that may fit this scenario.

Special Note: Non-secure platforms may be used such as Skype and FaceTime even though they are not HIPAA compliant, per federal instructions of the COVID-19 crisis.

The most common and required code for telemedicine is a standard evaluation and management code.

Evaluation and Management (E&M)

99201-99215

• The most common code billed and accepted for a virtual video visit.

• Many plans may prefer (require) E&M coding for virtual video visits

• Billing difference from an in-office physical face-to-face:

• Place of Service is 02 to indicate – a location where health services and health-related services are provided or received, through a telecommunication system.

• Modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.”

These visits most likely would be based on counseling as the overriding factor and therefore the code choice would be based on time. Documentation requirements would be the same as if the patient was physically in the office.

Online Digital Evaluation and Management Services

Note the following is intended for communications through an EHR portal  where  the patient can send communication via email or similar and the doctor responds via the same fashion.

E-visits: These visits use an online patient portal. These services are not a substitute for an in-person visit, but are exchanges with a practitioner online through a patient portal.

99421 (RVU 0.43) Online digital evaluation and management service, for an established patient,

for up to 7 days cumulative time during the 7 days; 5-10 minutes

99422 (RVU 0.86) 11—20 minutes

99423 (RVU 1.39) 21 or more minutes

These are patient-initiated E/M services for the assessment and management of the patient. These are not intended for the no evaluative electronic communication of test results, scheduling of appointments, or other communication that does not include E/M.

If the patient had an E/M service within the last seven days, these codes may not be used for that problem.

If the inquiry is about a new problem (from the problem addressed at the E/M service in the past 7 days), these codes may be billed.

“Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days.”

The digital service must be provided via a HIPAA compliant platform, such as an electronic health record portal, secure email or other digital applications. But this has been waived under the current status.

Calculate minutes for 99421-99423 To count the time for these codes, start the seven-day clock when the physician or qualified health provider first performs a personal review of the patient’s question. Add in the time for the review of relevant patient records and data, interaction with clinical staff regarding the patient’s problem, developing management plans (including prescriptions and test orders), and further communication with the patient by a digital means that doesn’t fall under another E/M code. Include decision-making, assessment, and management by those in the same group practice, too, but don’t count clinical staff time.

For the medical record, the guidelines instruct you to keep permanent documentation, either electronic or hard copy.

Telephone Calls

Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

99441 (RVU 0.40) 5-10 minutes of medical discussion

99442 (RVU 0.78) 11-20 minutes of medical discussion

99443 (RVU 1.14) 21-30 minutes of medical discussion

Exception- Anthem has indicated they will not pay hands on providers for phone calls only but video real-time visits face to face.

Compliance Billing Requirements

Consent:

• “…the health care provider initiating the use of telehealth shall inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health. The consent shall be documented.” Patient consent may be verbal or written. While there is no specific guidance for verbal consent, we advise including the following language once consent is granted:

“The patient consented to telehealth medical services being provided virtually via: XXXX”

Place of service for these codes is 02

Some payers may request a modifier and there can be some confusion as to which one. Note the 2 below though GT is not applicable but is for reference to have clarity.

95 Modifier

Modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.”

GT Modifier

GT modifier means “via interactive audio and video telecommunications systems” As of January 1, 2018, the GT modifier is only allowed on institutional claims billed under Critical Access Hospital (CAH) Method II since institutional claims do not use a POS code.

GQ modifier

This modifier is required to use for CIGNA claims for telemedicine services (E&M video visits) with the place of service remaining 11.