Wiki Audio only telehealth visit - seen within 7 days prior

[lgardner]

hello fellow coders-

I have a question, which I am not able to find the answer to (at least not as quickly as I'd like).

for audio only telephone visits (99441-99443): "Telephone or audio-only evaluation and management services for new and established patients, cannot originate 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.".

does this still apply if the patient was seen by a different provider/specialty 6 days before the televisit, but discussing the same issues?
**EDITED to add - the pt saw a cardiologist, and then had a phone call with his PCP 6 days later, the PCP followed the cardiologists recommendations and offered another referral**

thanks in advance!
- Lisa

 

[lgardner]

okay.

I am torn on this and cannot find any solid information, so if anyone could give me their thoughts/opinions on this, I'd appreciate it.

 

[csperoni]

While I've never seen it explicitly stated that way for audio visits, all other coding guidelines (new patient, global surgery, etc) apply to same group, same specialty. I would apply that same guideline here. The basic idea for same group, same specialty is that the practice is being paid for that work elsewhere and billing for it another way is trying to get paid twice for the same work.
I would consider the PCP audio visit to be billable.

 

[lgardner]

While I've never seen it explicitly stated that way for audio visits, all other coding guidelines (new patient, global surgery, etc) apply to same group, same specialty. I would apply that same guideline here. The basic idea for same group, same specialty is that the practice is being paid for that work elsewhere and billing for it another way is trying to get paid twice for the same work.
I would consider the PCP audio visit to be billable.

thank you, Christine.
that was my thought process, exactly, but not having something official, I started to second guess myself.