Wiki Telemedicine and Home Health Professional services

[Tewisdom]

Hello, I have questions regarding billing of E/M services for professional home or domiciliary visits performed via telehealth. I am having difficulty getting reimbursement from Anthem, when we will bill our standard cpt codes, 99349-99350 with the -95 modifier attached and the POS Code as 2 or 10. Per the virtual visits reimbursement guideline, I don't find that these services are not payable, but all of our claims are being denied. We billing the following E/M codes:
99341-99350 HOME
99324-99337 DOM
99304-99310 SNF
We also bill, CPT 99358 for prolonged service via telehealth and it is continuously denied. I don't know if I am interpreting the guidelines appropriately for this service.
Any suggestions would be great.

 

[TThivierge]

Hi Tewisdom
It could be well are you the selecting the right diagnosis codes reflecting the documentation(most Z codes should be last unless designated first listed Z dx codes)? As example Z74 block of dx codes CANNOT be first listed dx codes. Use the patient illness related to why getting home services such as I69, E11, I50, J44 Etc as first. Also do you list a referring doctor for these HOME services? Referring doc can be added to the claim . I believe in CPT manual it says cannot use Prolonged service CPT 99416-99415 for HOME service. I don t think can bill telehealth 99358 95 with mixed face to face CPT codes. Check out on CMS website each CPT code 99341 and see if rules listed modifiers and dx linked.
I hope I helped a bit
Lady T