Orthopedic Coding Alert

Note: Reserve HCPCS code G2010 (Remote evaluation of recorded video and/or images…) for “store and forward” services in which a patient sends a practitioner an image or video and the practitioner responds within 24 hours.

Patient Portal Communication = E-Visit

The third type of virtual service you’ll want to consider is an e-visit. “E-visits — digital communication — take place through a secure online portal,” relays Natalie Ruggieri-Buzzelli, CPC, CGSC, HIM coding specialist at the Hospital of the University of Pennsylvania.

“E-visits are a patient-initiated encounter between a physician or other qualified healthcare professional. If the inquiry is related to a surgical procedure within a global period, then the service is not reported. The provider must keep a permanent record on file. Other rules apply and are listed in the CPT^® manual,” outlines Ruggieri-Buzzelli.

E-visits are exclusive to established patients and may include time spent for interaction for up to seven days. This means that providers must document the time associated with each interchange in order to add up the time spent at the end of the seven-day period. E-visits may be performed by physicians or advanced practice providers (APPs) using one of the following three time-based E/M codes:

• 99421 (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 (…11-20 minutes)
• 99423 (… 21 or more minutes).

Don’t forget: The fourth type of virtual care involves remote monitoring via code range 99453-+99458, in addition to code 99091 (Collection and interpretation of physiologic data…requiring a minimum of 30 minutes of time, each 30 days). This can include remote heart monitoring, blood pressure monitoring, blood sugar monitoring, etc. These services not only provide extensive data to the provider, but also ongoing feedback to the patient.

Round Out Your Knowledge With Modifier Guidelines

There are four modifiers you’ll want to consider for telehealth (audiovisual) code reporting:

• 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system)
• GQ (Via asynchronous telecommunications system)
• GT (Via interactive audio and video telecommunication systems)
• G0 (Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke).

Medicare Part B requires the use of modifier 95 on telehealth claims during the extent of the PHE. Some commercial payer policies also require that you append modifier 95 to telehealth claims. You should check on individual payer guidelines prior to reporting modifier 95 with your claims for non-Medicare Part B payers.

The remaining three modifiers are based on circumstantial and/or location considerations. According to CMS, you should only report modifier GQ when the telehealth service is furnished “via asynchronous (store and forward) technology as part of a federal telemedicine demonstration project in Alaska and Hawaii.” Furthermore, modifier GT is designated for billing under Critical Access Hospital (CAH) Method II. Modifier G0 may be used universally among providers and locations so long as the criteria for the modifier has been met.

Get Some Essential POS Background Knowledge

The place of service (POS) code that you use for telehealth claims should be the place where the service would have been traditionally provided had it been a face-to-face visit.

That’s because all telehealth services provided during the PHE are considered “nontraditional” telehealth services.

With a traditional telehealth service, Medicare pays the “originating site” the facility fee, leaving the provider with a reduced fee that takes out the overhead paid to the originating site. Since providers are still incurring overhead and there is no facility fee paid to an originating site, CMS has determined that the reduction in the fee schedule is not justified. This means that an office visit performed over telehealth under the PHE would be billed with a 95 modifier and POS of 11 (Office) for the office, even though the provider and patient may be communicating from their respective homes.

For telehealth claims that a provider would typically perform outside of the office, you’ll want to make sure to use the correct POS code for the respective location. For instance, emergency room visits will require a POS of 23 (Emergency room – hospital) and subsequent hospital visits will require a POS of 21 (Inpatient hospital).

With respect to virtual check-ins and E-visits, you’ll want to report POS code 11, not POS code 02 (Telehealth) for Medicare Part B claims in addition to (some) commercial payers.

You will also report remote physiologic monitoring codes with POS 11.

Disclaimer: Information related to COVID-19 is changing rapidly. This information was accurate at the time of writing. Be sure to stay tuned to future issues of Radiology Coding Alert for more information. You can also refer to payer websites, CMS (cms.gov), CDC (cdc.gov), and AAPC’s blog (www.aapc.com/blog) for the most up-to-date information.