Does anyone know, based on a legitimate coding source, whether or not an "inpatient" subsequent telephone visit is billable - and if so, how? I have a specialty who provided an inpatient face to face consult - but then the very next day, a different provider, in the same specialty group, decided to do a subsequent visit via telephone because the patients covid test result was not back yet and they did not want to risk exposure. The patient was in their room and the provider was at the nurses station. The patient was not seen by this specialty group again until 3 days later and from that point on, all visits were face to face as the covid result was negative. I have one coder saying the visit is completely not billable at all - but other coders saying that it is billable with a regular subsequent inpatient e&m code because the provider and patient were in the same location, same bldg, same floor, etc. and therefore, the visit did not meet telephone visit criteria. Any and all help would be greatly appreciated!
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Wiki INPATIENT TELEPHONE VISIT
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I believe this may be billed as 99231-99233 because the provider is at the same physical location as the patient.
From CMS: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Specifically, page 61 under telehealth, question 9 (bold added for emphasis):
9. Question: Should on-site visits conducted via video or through a window in the clinic suite be reported as telehealth services? How could a physician or practitioner bill if this were telehealth? Answer: Services should only be reported as telehealth services when the individual physician or practitioner furnishing the service is not at the same location as the beneficiary. If the physician or practitioner furnished the service from a place other than where the beneficiary is located (a “distant site”), they should report those services as telehealth services. If the beneficiary and the physician or practitioner furnishing the service are in the same institutional setting but are utilizing telecommunications technology to furnish the service due to exposure risks, the practitioner would not need to report this service as telehealth and should instead report whatever code described the inperson service furnished. New: 4/9/20
From CMS: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Specifically, page 61 under telehealth, question 9 (bold added for emphasis):
9. Question: Should on-site visits conducted via video or through a window in the clinic suite be reported as telehealth services? How could a physician or practitioner bill if this were telehealth? Answer: Services should only be reported as telehealth services when the individual physician or practitioner furnishing the service is not at the same location as the beneficiary. If the physician or practitioner furnished the service from a place other than where the beneficiary is located (a “distant site”), they should report those services as telehealth services. If the beneficiary and the physician or practitioner furnishing the service are in the same institutional setting but are utilizing telecommunications technology to furnish the service due to exposure risks, the practitioner would not need to report this service as telehealth and should instead report whatever code described the inperson service furnished. New: 4/9/20
Thank you so much for the reply. I did find that source and brought that to a coders attention, but their response was that it simply stated "telehealth", and that the question asked was about a visit via video or through a window in the clinic suite -- it does not specifically mention a telephone visit. Their understanding is that with a video visit or seeing the patient thru a window is still, at some level, considered a face to face (per sa) - whereas with a telephone visit, there is no face to face at all, unlike doing it thru a video feed or from a distance. I am inclined to believe that the answer was intended to mean that telehealth in this CMS response is for video or telephone. Any thoughts?
SharonCollachi
Guest
I think the important part is "telecommunications due to exposure risks", which this situation qualifies for. The word "telecommunications" means communications through electronic means, not specifically telephone or visual means. Does it matter if they are talking through a window, or looking through a window and talking through a phone at the same time? I am inclined to think the SPIRIT OF THE LAW, so to speak, says no, it doesn't matter. The intent is to reduce the risk, therefore, report as in-person and not as telehealth.