Urology Coding Alert

Stick to one set of codes for reporting until the PHE ends.

Even for those who did their due diligence by reading through the release of the 2021 Medicare Physician Fee Schedule (MPFS) final rule, it would be perfectly understandable if you missed a small portion that covers new coding guidance for telephone-based virtual check-in services.

While most of the hype up until this point has been surrounding telehealth coding and reporting, the Centers for Medicare and Medicaid Services (CMS) has decided to invite audio virtual check-ins to the party by adding a new Medicare-exclusive code for 2021 reporting. However, just because this code is now eligible for reporting, doesn’t necessarily mean you should be reporting it.

Get a first-hand look at this new audio virtual check-in service code and get proper virtual check-in coding guidance to ensure you’re maximizing your provider’s bottom line.

See What’s New With 2021 Virtual Check-in Coding

At the beginning of the public health emergency (PHE), you were introduced to all kinds of coding guidance on reporting for telehealth services, virtual check-ins, and e-visits. Despite the majority of attention being paid to telehealth coding, virtual check-ins have remained a constant and integral part of urology practice E/M services as the PHE extends into 2021.

Refresher: Technically, a virtual check-in includes any brief patient communication with a provider via a number of communication technology modalities. These may include telephone or asynchronous (staggered response) exchanges through video or image. This article focuses on synchronous audio exchanges, typically via telephone, that qualify as virtual check-in services.

While the concept is generally straightforward, the coding dynamics require some extra attentional to detail in order to ensure your provider is not only billing for the correct services, but it is also compensated appropriately. With the release of the MPFS 2021 final rule, there’s been some added confusion surrounding what codes to report for Medicare Part B and other commercial payer virtual check-in services. The confusion began with the recent introduction of the following HCPCS Level II code:

• G2252 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 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; 11-20 minutes of medical discussion).

As CMS puts it, this is essentially an indented code to G2012 (… 5-10 minutes of medical discussion) and is eligible for Medicare Part B (and other eligible commercial payer) reporting.

Consider Provider Eligibility for Some Virtual Check-in Codes

Your first point of order is to distinguish G2252 from the following two new virtual check-in codes, also released in 2021:

• G2250 (Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward…)
• G2251 (Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services… 5-10 minutes of clinical discussion)

These codes are designated to be reported by practitioners who cannot independently bill for E/M services. CMS refers to these G2250 and G2251 as “sometimes therapy,” which may be billed by a private practice physical therapist (PT), occupational therapist (OT), and speech language pathologists (SLPs), among other non-physician providers (NPPs). Alternatively, you will report G2010 (Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward) …) for store and forward services by advanced practice providers (APPs) treating patients with Medicare Part B and other eligible payers.

Maximize Reimbursement With These Coding Adjustments

With the release of G2252, the underlying question E/M coders are now scrambling to answer is whether to report G2012 and G2252 in place of the following CPT^® codes for telephone-based E/M services:

• 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided 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; 5-10 minutes of medical discussion)
• 99442 (…11-20 minutes of medical discussion)
• 99443 (… 21-30 minutes of medical discussion)

You might recall in March of 2020 that CMS announced that it would temporarily extend coverage for 99441-99443 as virtual check-in service codes for the duration of the PHE. CMS explains in the 2021 MPFS final rule that G2012 and G2252 are direct crosswalks to 99441 and 99442, respectively. Furthermore, considering that CMS extended coverage to 99441-99443, and the 99441-99443 respective fee schedules offer substantially more compensation than G2012 and G2252, the question begs: What circumstances, if any, should G2012 and G2252 be reported for eligible clinical virtual check-in services?

Fortunately, the answer is as straightforward as it seems while the PHE is ongoing. Until CMS announces coverage of 99441-99443 has ceased, you should be reporting it for all eligible (Medicare Part B and otherwise) telephone-based virtual check-in services. You’ll find that the fee schedule for 99441-99443 yields substantially more reimbursement than G2012 and G2252. Furthermore, CMS’ creation of a crosswalk between code sets does not mean that both codes sets will be reimbursed the same. The respective fee schedules for both code ranges still apply. Keep in mind that, on a longer timeline, the answer isn’t as straightforward until congress makes a legislative decision on the future of telehealth.

Coder’s note: The 99441-99443 code description clearly indicates the known 8-day exclusion rule, in which the virtual check-in may not originate from a related E/M service within the prior 7 days, nor may you report it when the check-in leads to an E/M service within the next 24 hours (or soonest available appointment thereafter). “However, keep in mind that there’s at least one Medicare Administrative Contractor (NGSMedicare) that has eliminated those exclusion dates,” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, of CRN Healthcare in Tinton Falls, New Jersey. “Check with your local Medicare Administrative Contractor (MAC) to confirm that that the 8-day exclusion period still applies,” Cobuzzi advises.