Wiki New Telehealth Codes

[HCampain]

So I need some help and this is the only place I figured I could go to get opinions/facts. As of right now my clinic is getting denials for the new telehealth codes from certain insurances. So far it's looking like BCBS, GEHA, UMR, BCBS, Multiplan PHCS, and Ambetter is accepting all but the highest level of video or audio. Billing is stating the insurance has it's own rules and we must follow them, which I understand as an FQHC facility but I don't think I'm comfortable charging an E/M if they did telehealth. Can someone please advise what I should do for this? Thank you!

 

[jkyles]

Hi there, unless you have a payer that says use the face-to-face E/M codes for telehealth office visits (as Medicare does), you should not report a face-to-face code. What will likely happen is the payer will reject it based on the place of service. However, the RVUs for the in-person codes are higher than the telehealth codes so it could also look like you're trying to get the higher payment.

 

[HCampain]

Hi there, unless you have a payer that says use the face-to-face E/M codes for telehealth office visits (as Medicare does), you should not report a face-to-face code. What will likely happen is the payer will reject it based on the place of service. However, the RVUs for the in-person codes are higher than the telehealth codes so it could also look like you're trying to get the higher payment.

First off, thank you for taking the time out to help me. Second, what is happening is, let's just say a UMR comes across my screen and the progress note specifically states "pt was seen using 2 way audio and video" Or "pt had issues connecting to audio and video so they opted to do a telephone encounter instead" and instead of using the new telehealth codes they are denying unless we change them out with, say, a 99213 or 99214 with a mod 95. Is that fraud? I don't want to risk my cert because billing isn't wiling to dig a little deeper. Does that make sense?

 

[jkyles]

Sure thing.

1. I wouldn't think of it in terms of whether it is fraud. Fraud is a crime and requires a finding of guilt. Think instead in terms of whether it is compliant coding.

2. If the payer wants audio/video telehealth encounters reported that way, that's how you should do it.

For the audio-only visits, I think you need more clarity. Modifier 95 says the provider could see and hear the patient during the encounter. Modifier 93 is the audio-only modifier and some payers that cover A/V encounters will not cover audio-only visits. The other issue gets into protecting the provider: If the provider can only hear the patient, they might miss some issue that they would have seen during an A/V call. Therefore the claim should reflect that the provider could only hear the patient.

 

[vnorman]

Does anyone have any information or can possible give me some assistance regarding replacement codes for digital E/M services? I have a client that is performing Portal Messaging with the patients. They are sometimes pretty in-depth and time consuming. The office used to bill with codes 99421 - 99423 but of course these are no longer valid I am unable to find codes that will cover the services now. I am looking for any assistance.

 

[jkyles]

Does anyone have any information or can possible give me some assistance regarding replacement codes for digital E/M services? I have a client that is performing Portal Messaging with the patients. They are sometimes pretty in-depth and time consuming. The office used to bill with codes 99421 - 99423 but of course these are no longer valid I am unable to find codes that will cover the services now. I am looking for any assistance.

I answered this elsewhere.