Wiki Can you bill a Telehealth Visit and an office visit the same day by the same provider? 99212, 99214

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The provider did a telehealth visit and the patient came in to see the nurse, the provider wants to bill for the telehealth visit and the nurse visit on the same day? I am fairly new to Telehealth, is this appropriate? please provide a link to support to show provider.
 
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Per the AMA guidance, above, in Scenario 3 and Scenario 21, it states both telehealth and 99211 may be billed if the patient is coming for Covid 19 testing or Covid 19 antibody testing. It does not address specifically if the patient is coming for another reason (BP check, other testing, etc.), but I would extrapolate the same advice.
While my personal opinion may not be the same, the AMA guidance is they may be billed separately.
 
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csperoni said:
Per the AMA guidance, above, in Scenario 3 and Scenario 21, it states both telehealth and 99211 may be billed if the patient is coming for Covid 19 testing or Covid 19 antibody testing. It does not address specifically if the patient is coming for another reason (BP check, other testing, etc.), but I would extrapolate the same advice.
While my personal opinion may not be the same, the AMA guidance is they may be billed separately.
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Thank you, I agree, the provider performed a Telehealth visit, and the patient came in the same day for an injection due to an allergic reaction codes billed for the office visit 99212, 25, J1100, and 96372, with a primary dx of z888 for all codes on the claim, followed by z7952. For the Telehealth visit codes billed 99214 with a primary dx of z7689, followed by T7840xa, z888, T886xxa, BCBS is the insurance, we have Athena and Athena has put a hold on the claim with the injection stating Per payor guidelines, only one E&M procedure code is likely to be covered per date of service per patient for the same physician.
 
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Question - did the provider decide during the telehealth that the patient needed an injection and then only saw the nurse? You indicated in your original post that the patient saw the nurse only in person. 99212 is not appropriate for a nurse visit, it would be 99211 which does not require provider. Additionally, the injection would be included and bundled with 99211.
Besides that, the insurance carrier can add whatever additional guidelines they want. Simply because the AMA guidance is that it may be billed does not mean the carrier will cover it.
 
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csperoni said:
Question - did the provider decide during the telehealth that the patient needed an injection and then only saw the nurse? You indicated in your original post that the patient saw the nurse only in person. 99212 is not appropriate for a nurse visit, it would be 99211 which does not require provider. Additionally, the injection would be included and bundled with 99211.
Besides that, the insurance carrier can add whatever additional guidelines they want. Simply because the AMA guidance is that it may be billed does not mean the carrier will cover it.
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the provider completed the telehealth visit and advised the patient to come to the office for the injection, yes I agree the nurse visit should be 99211 and the injection is bundled, but is the telehealth and the nurse visit covered on the same day, my thought process is to bill the telehealth visit and the injection. I don't enter the charges I catch it on the back end. Also they added the 25 modifier to the 99211. Is there any documentation printed on this bundle anywhere?
 
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According to the AMA guide, a telehealth and a 99211 in person for Covid testing or Covid antibody testing is billable the same day (whether or not it's payable is up to the carrier).
However, in your situation, there is no justification to bill a 99211. NCCI edit for 99211 bundled in 96372. (If you don't have software to check NCCI edits, you can find them on the Medicare website but the website and file is very cumbersome. To me, it's the number 1 reason to have encoder software.) No modifier can override this column 2 edit. Even IF a modifier could, -25 is not appropriate when the provider already decided patient needs an injection at the telehealth.
Additionally, here is a good Noridian article about the use of 99211 https://med.noridianmedicare.com/web/jeb/cert-reviews/cert/99211-and-incident-to
"If the sole purpose of a visit to the physician's office is to draw blood or receive an injection, then 99211 should not be billed and only the appropriate injection or blood drawing code should be billed."
 
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