Question Follow ups scheduled as telehealth visit.

[flowergrl]

I have a provider who is scheduling remote/telehealth visits for a future date. These can be either telephone visits (audio only) or audio-video visits, depending on the patients level of virtual knowledge. I know telehealth coding has changed a lot in the past few years with Covid, and some rules have been extended and/or made perm.

My understanding of audio only visits, is it has to be initiated by the patient (as in not pre-scheduled by the providers office) and cannot be less than 7 days from an office visit or 24 hours before an office visit. Is this true? The provider cannot see the patient in the office and say "we'll do a telephone follow up in 1 week" and bill for it?

My understanding is that they cannot bill for just going over lab results, unless the call would include extensive medical decision making and has medical necessity during the call, which would then use 99441-99443 based on time of call.

And another question... can the provider do this if it's audio-video? or... is there EVER a time when a provider can see a patient in the office, then schedule a follow up more than 7 days out as a remote check up or follow up?

I understand the audio-video codes are used with the regular office visit E/M codes with POS11 and modifier 95 still, until 12/2024?

 

[jkyles]

Hi there. Just FYI my answers are based on Medicare's current rules (including waivers) for telehealth.

Please review the guidelines in your CPT manual for full details on telephone E/M visits. But essentially you are correct regarding the time limits for a telephone visit before or after a standard E/M visit.

In addition, while the call for going over lab results alone does not qualify for a telephone visit, it also would not be appropriate to require the patient to call to get their test results in order to possibly charge a visit based on the amount of work the provider performs.

The telehealth (audio/video) visit must follow the rules for a standard E/M visit, so if the provider would normally schedule a face-to-face visit for a follow up, they are good to go for a telehealth visit.

If you're asking about remote visits like G2010 and G2012, they also have similar restrictions to the telephone visits, so no. It might help to remind providers that follow up work is included in the revenue they receive for the E/M visit.

For POS and modifier - that is also correct.