Answer Coding / Billing Audio-Only Telehealth Visits

KStaten

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Hello Everyone! :)

Here's my silly question for the day. (Brace yourselves, as I am sure more are to come. ;) ) As I have interpreted from articles, the accepted Telehealth services have been expanded to include audio-only telephone calls, as well. (Yay!) Now this is the part where I am overthinking (in reference to outpatient visits) :
  • The logical side of my brain is saying that we still use the Telephone, Non-Face-to-Face Service Codes (99441-99443)... since, of course, that's what these are.
  • The illogical side of my brain (that attempts to argue both sides of true/false questions 🤷‍♀️) has that nagging question as to whether, since these have been included as the expansion, do we bill them in the same manner, as they are allowing us to bill the audio/ video visits as regular office visits (99201-99215)?
I'm fairly confident that the "logical side" of my brain is correct on this one, but, as always, I would appreciate you to set me straight. :) (ALSO, if we use the 99441-99443 codes, it is a requirement for time to be documented during audio-only calls since that is an inherent part of the code, correct?)

Thank You in Advance! :)
Kim
 

csperoni

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Ignore your illogical side. 😁
The CMS guidance was that telephone encounters 99441-99443 were historically not covered, but will now be covered during the emergency. Telephone (audio only) is billed 99441-99443 and MUST have time documented.
I will note that SOME private payors (Cigna comes to mind) have decided that telephone encounters may be billed 99201-99215 at this time. That is NOT the CMS guidance. Unless you have a written policy from the carrier stating otherwise, telephone encounters use 99441-99443 or G2012.
 

KStaten

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Thank you, Christine! 😊 I need people like you to keep me in line. I propose that all of the insurance companies get together on a single, joint-effort website and upload their coding / billing policies for standard services, such as these. 😃
 

csperoni

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99441-99443 do not require modifiers. POS 11. At least, that is the CMS guidance. I have not heard any private carriers wanting modifiers for 99441-99443, but it's certainly possible.
 
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I have a different question - can anyone tell me if a patient does not have the ability to use audio video for a telehealth visits and we have to use the phone in place of the audio/video - can we bill this with the telehealth codes (EM) or do we need to use the telephone codes. CMS has stated that the telehealth codes are to be used for the visits that would normally be done in the office which this one was, but this patient did not have the internet. Telephone codes are not listed under the telehealth codes. CMS has also stated that those who do not have this technology can still be billed under telehealth. Can we bill these with the telehealth EM codes? of do we need to use the Telephone codes?
 

csperoni

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I think my original answer addresses this.
For CMS, it is definitely 99441-99443 or G2012 if no video. Most private carriers are also stating no video, no E/M. Some carriers (Cigna) have stated audio only may be billed with E/M, but that is NOT the official CMS guidance.
Telephone only is 99441-99443 unless you have written official guidance from a private carrier stating otherwise.
Ignore your illogical side. 😁
The CMS guidance was that telephone encounters 99441-99443 were historically not covered, but will now be covered during the emergency. Telephone (audio only) is billed 99441-99443 and MUST have time documented.
I will note that SOME private payors (Cigna comes to mind) have decided that telephone encounters may be billed 99201-99215 at this time. That is NOT the CMS guidance. Unless you have a written policy from the carrier stating otherwise, telephone encounters use 99441-99443 or G2012.
I have a different question - can anyone tell me if a patient does not have the ability to use audio video for a telehealth visits and we have to use the phone in place of the audio/video - can we bill this with the telehealth codes (EM) or do we need to use the telephone codes. CMS has stated that the telehealth codes are to be used for the visits that would normally be done in the office which this one was, but this patient did not have the internet. Telephone codes are not listed under the telehealth codes. CMS has also stated that those who do not have this technology can still be billed under telehealth. Can we bill these with the telehealth EM codes? of do we need to use the Telephone codes?
 

KStaten

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I have a different question - can anyone tell me if a patient does not have the ability to use audio video for a telehealth visits and we have to use the phone in place of the audio/video - can we bill this with the telehealth codes (EM) or do we need to use the telephone codes. CMS has stated that the telehealth codes are to be used for the visits that would normally be done in the office which this one was, but this patient did not have the internet. Telephone codes are not listed under the telehealth codes. CMS has also stated that those who do not have this technology can still be billed under telehealth. Can we bill these with the telehealth EM codes? of do we need to use the Telephone codes?
I think that was the same question I had asked (in a different way), and the same reason I had gotten confused. ;) So, Christine's answer should apply to both. :)
 
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trarut

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I think my original answer addresses this.
For CMS, it is definitely 99441-99443 or G2012 if no video. Most private carriers are also stating no video, no E/M. Some carriers (Cigna) have stated audio only may be billed with E/M, but that is NOT the official CMS guidance.
Telephone only is 99441-99443 unless you have written official guidance from a private carrier stating otherwise.
Agreed. My research has turned up that UHC and Cigna are the only two major payers allowing E/M codes for audio-only visits. Optima is requiring POS 02 for all telehealth codes - I guess they just want to be different ;)
 

guamafb@gmail.com

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Good morning. I am stuck on distinguishing the difference between 99441-3 and G2012? G2012 can cover a broad range of communication, 99441-3 is phone only Both have rules regarding previous 7 days and next 24 hour visits. Just not sure what I am looking for to distinguish between the 2 code sets, except that G2012 applies to audio, digital, or visual communication, any option for 5-10min. and 99441- is telephone only. Any suggestions are greatly appreciated. Thanks
 

csperoni

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Good morning. I am stuck on distinguishing the difference between 99441-3 and G2012? G2012 can cover a broad range of communication, 99441-3 is phone only Both have rules regarding previous 7 days and next 24 hour visits. Just not sure what I am looking for to distinguish between the 2 code sets, except that G2012 applies to audio, digital, or visual communication, any option for 5-10min. and 99441- is telephone only. Any suggestions are greatly appreciated. Thanks
There is clearly significant overlap in 99441 and G2012, but there are a few differences.
Basically, the entire reason there are 2 different codes is that CMS historically did not cover 99441-3, but would permit G2012 check-in. 99441-3 have been approved to use for new patient during the emergency, but not G2012.
An established pt with 5-10 minute phone call can be billed to Medicare as either G2012 or 99441. The reimbursement is pennies apart. Private carriers may only pay one or the other, depending on their policy.
In our practice, we are using 99441-3 and built a rule into the billing system for the carriers that want G2012 instead.
 
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