Billing Telehealth with E/M coding

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I am needing some clarification, I have multiple providers of different specialties that are wanting to provide the telehealth services but CMS guidelines are vague and confusing when it comes to inpatient and skilled nursing. I have reviewed all the guidelines and everything on line and still no clarification on the following codes.

• Subsequent hospital care services, with the limitation of one telehealth visit
every 3 days (CPT codes 99231, 99232, and 99233) – Here is the question if the patient is in patient how do they determine the every 3 days. If a patient is in the hospital they are "normally" being seen by a physician daily. Is there a way to make this more clear for my providers?

• Subsequent nursing facility care services, with the limitation of one telehealth
visit every 30 days (CPT codes 99307, 99308, 99309, and 99310) – The question is if the patient is in Nursing Home and has multiple episodes what determines the 1 telehealth visit every 30 days. Is there a clear way to determine this for my providers?:confused::confused::confused:
 

thomas7331

True Blue
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I'd recommend reading through section 190 of the Medicare Claims Processing Manual Chapter 12, if you haven't already looked at that:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

As I read it, telehealth service is for an attending provider to be able to get assistance from a specialist when the patient is being treated in a facility that is located in an area that does not have that specialty readily available on site. The way the regulation reads, telehealth isn't meant to replace daily in-person visits, but is available to give periodic ongoing support by the specialist to the attending physician. As described in 190.3.3, the subsequent inpatient and nursing visit codes are to be used for follow-up consultations.

In my experience, if a patient needed care by a specialist more frequently than that what is allowed through telehealth, the facility would not keep the patient in house, and would require that the patient be transferred to another location where that service is available. Not sure if that helps to answer your question?
 
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