Successfully Report Medicare Teleconferences
The Centers for Medicare & Medicaid Services (CMS) allows coverage for telehealth consultations, using dedicated G codes. Codes describing initial telehealth consultations apply to inpatients, including those in a skilled nursing facility (SNF), or to patients in an emergency department (ED):
G0425 Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth [problem focused history, problem focused examination, straightforward medical decision making]
G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth [detailed history, detailed examination, moderate complexity medical decision making]
G0427 Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth [comprehensive history, comprehensive examination, high complexity medical decision making]
Follow-up codes similarly apply to SNF or hospital inpatients, as well as to ED patients:
G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth [problem focused history, problem focused examination, straightforward medical decision making]
G0407 Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth [detailed history, detailed examination, moderate complexity medical decision making]
G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth [comprehensive history, comprehensive examination, high complexity medical decision making]
Per the Medicare Claims Processing Manual, Chapter 12, section 190.3.1, subsequent hospital care services are limited to one telehealth visit every three days. Subsequent nursing facility care services are limited to one telehealth visit every 30 days.
Whether reporting initial or follow-up services, the provider must meet all three required elements (history, exam, MDM) to bill a particular level of service. For example, to report G0407, the provider must document at least a comprehensive history, a compressive exam, and high complexity MDM.
Documentation Must Meet Consult Requirements
To demonstrate that the service matches the CMS definition of a consult, documentation should verify the following elements:
- A request for opinion or advice, and a stated reason to substantiate the need for the service. Because the consulting provider bills the service, it’s in his or her best interest to document the request as part of the patient record. Specify that the visit is “consult” (not, for instance, a “referral,” which may signify to the payer a transfer of care rather than a request for consultation). If possible, ask the requesting provider to make the request in writing (e-mail, fax, a note sent with the patient, etc.), and make that part of the record, too.
- A report from the consulting provider, back to the requesting provider. The service is justified only if the consulting physician gives his opinion and/or advice to the requesting provider. Without a report back to the requesting provider, a consultation hasn’t occurred.
Originating Site Must Be Qualified
Telehealth services are available only to those patients in a qualified originating site. Telehealth originating sites must be located in a designated rural Health Professional Shortage Area (HPSA), located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract, or a county outside of a MSA. To determine a potential originating site’s eligibility for Medicare telehealth payment, visit the CMS website.
Face-to-Face (Usually) a Requirement
Medicare pays only for interactive video consultation services that mimic face-to-face interactions between patients and providers. CMS stipulates that video telecommunications system must permit “real-time communication between … the physician or practitioner at the distant site, and the beneficiary, at the originating site.”
When reporting an approved telehealth service, you must append modifier GT Via interactive audio and video telecommunications systems to the appropriate service code(s). The modifier tells your Medicare contractor that
the beneficiary was present at an eligible originating site when the telehealth service was furnished.
“Asynchronous ‘store and forward’ technology” (e.g., video clips, still images, X-rays, MRIs, EKGs and EEGs, laboratory results, audio clips, and text) is covered only in Federal telemedicine demonstration programs in Alaska or Hawaii. For non “face-to-face” telehealth services, report the appropriate code for the professional service with modifier GQ Via an asynchronous telecommunications system appended.
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