Cardiology Coding Alert

Don't miss new Appendix P for telemedicine services.

Because cardiology is a fast-paced specialty on the forefront of technology, telemedicine isn't necessarily a new concept for cardiologists. So when CPT^® 2017 identified the codes you can report for telemedicine, cardiology definitely didn't get off light. Learn the ins and outs of telemedicine to protect your practice today.

Tip 1: Decode Medicare Telemedicine Service Requirements

Medicare defines telemedicine as "medical or other health services given to a patient using a communications system (like a computer, phone, or television) by a practitioner in a location different than the patient's" (www.medicare.gov/glossary/t.html).

The general rule is that Medicare will pay for telemedicine services under the Medicare Physician Fee Schedule (MPFS) only if the service meets all of the following requirements:

• The service must be on the list of Medicare's approved telemedicine services
• A physician or other authorized practitioner must provide the telemedicine service 
• The patient must receive the telemedicine service at an accepted telemedicine originating site 
• The patient who receives the service must be eligible for telemedicine services
• When conducting telemedicine services, the physician must use interactive, real-time 2-way telecommunications equipment that includes both audio and video (there are limited exceptions for specific programs).

You can find more information about Medicare's telemedicine service requirements in the 2017 physician fee schedule final rule available under Related Links at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1654-F.html. The end of page 80192 (PDF page 23) is a good place to start.

Tip 2: Understand New Appendix P and Star Symbol

In the 2017 AMA CPT^® manual, Appendix P lists the 79 codes you can use to report synchronous (real-time) telemedicine services. Also new for 2017, CPT^® identifies the appropriate telemedicine codes with a star (★) symbol next to the code in the code set. Examples of Appendix P cardiology options include these codes:

• 93228-93229, External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days ...
• 93268-93272, External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring ...
• 93298-93299, Interrogation device evaluation(s), (remote) up to 30 days ... 

Note: The introductory text with Appendix P indicates that appending modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) to the codes in the appendix is appropriate when reporting real-time telemedicine services. See Tip 4 below for more on modifiers.

Tip 3: Discover Telemedicine POS Code 02

According to an MLN Matters article released on Aug. 12, 2016, CMS has created a new place of service code: POS 02 (Telehealth: The location where health services and health related services are provided or received, through telecommunication technology) for telemedicine. To read the full MLN Matters article, head to www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9726.pdf.

Physicians working from a distant site who do not use POS 02 when reporting their telemedicine services, effective as of Jan. 1, 2017, will receive a denial, says CMS.

Tip 4: Know When to Choose Modifiers GT/GQ vs. Modifier 95

For Medicare, when you report interactive telemedicine services with POS code 02, you must append modifier GT (Via interactive audio and video telecommunication systems) to the appropriate CPT^® or HCPCS code. If you're part of one of the limited programs that allows asynchronous (store-and-forward) technology, modifier GQ (Via asynchronous telecommunications system) may apply. If you use the POS code 02 without the appropriate GT or GQ modifier, or vice versa, your Medicare Administrative Contractor (MAC) will deny the service.

This year, CPT^® has given you a new telemedicine modifier - modifier 95 - to report telemedicine services your physician provides via real time, interactive audiovisual telecommunications.

Why modifiers? "It's important for the payers to know if the patient was physically in the office or seen via telemedicine," says Suzan Hauptman, CPC, CEMC, CEDC, senior principal of ACE Med group in Pittsburgh, Pa. "Because the codes are the same regardless of physical location, the 95 modifier tells this part of the story."

As for knowing which modifier to choose for real-time services, "practices should check with their respective payers on telemedicine coverage policies and the use of the appropriate modifier - 95 or GT," says Mary I Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc.

Bonus documentation tip: Hauptman offers advice for both the physician and the originating site concerning correct documentation.

"The documentation should clearly illustrate that the service is being provided via a telemedicine real-time portal where the patient and the physician can interact immediately with one another," says Hauptman. "The documentation should then illustrate the details of the examination, the history retrieval, the decision making, or any other component necessary for the substantiation of the billed service code."