Wiki auditing curb side or tent visits

[jmcalister]

How are urgent care facilities offering curb side visits auditing those visits? Are you using the regular 95 and 97 guidelines. I posted last week about telehealth and realized time and MDM could be used. These visits are being done outside. The CMO thinks it should be fine but fore me the DX is exsposure only no exam and hpi sometimes discusses travel or just whereabouts regarding exposure no exam. He wants me to slap a code on there but how can I if there is no tool to justify the level of care.

Does anyone have a tool or something and black and white that gives guidance on these circumstances
thanks
Jenn

 

[csperoni]

I don't bill for urgent care, but in person visits cannot use the telehealth guideline of leveling by MDM only. Time (if counseling coordination of care is >50% of total time) may be used, the same as all other in person visits.
CMS had advised 99211 was appropriate for collecting the covid specimen, when billed by physician offices. There are other appropriate G codes for laboratory use.
On page 9 of 128: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
"Medicare is also paying for specimen collection by hospital outpatient departments and physician offices at their locations. Hospital outpatient departments can use new HCPCS code C9803 to bill for a clinic visit dedicated to specimen collection. This service is conditionally packaged and only receives separate payment when it is billed without another primary covered hospital outpatient service or with a clinical diagnostic laboratory test that is assigned status indicator "A" in Addendum B of the OPPS. Physician offices can use CPT code 99211 when office clinical staff furnish assessment of symptoms and specimen collection incident to the billing professional’s services for both new and established patients. When the specimen collection is performed as part of another service or procedure, such as a higher level visit furnished by the billing practitioner, that higher level visit code should be billed and the specimen collection would not be separately payable. Physicians can bill for services provided by pharmacists incident to their professional services consistent with requirements under 42 CFR 410.26 and state scope of practice and license requirements. The specimen collection codes (which do not include CPT code 99211) are only active during the PHE."

So if the services provided meets higher than 99211 requirements, bill the higher level E/M, and the collection is included.

I hope this helps.