PROVIDER NOT THE OFFICE BUT BILLING FOR OFFICE VISIT

dfincher

New
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5
Location
Texarkana, AR
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I have a OB/GYN provider that was positive for COVID and was at home for a week. The RN provided services then had the patient talk to the doctor on the phone. Now he is trying to dictate like he was in the office. He is billing is 99203- 99214. I'm trying to tell him at best it's a telehealth. Please help me!!
 

vinessachilders

Networker
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29
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It depends on the payer, actually. For BCBS of AR, they instructed audio only telehealth be coded as if it were audio/video telehealth. For other payers, you would have to check.
 

thomas7331

True Blue
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Agree with the response above - if the provider only spoke with the patient by phone and did not have a real-time audio/visual, then the office visit codes 99201-99215 can only used if the payer allows a phone visit to meet the requirements for a telehealth visit. (In which case a modifier 95 and/or place of servcie 02 would need to be added to the claim.)

If the payer does not allow a phone call to be coded as telehealth, then the correct CPT codes for these service are 99441-99443.
 

csperoni

True Blue
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1,613
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Selden
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Yes, the note should not appear as though he was present and personally examined the patient. It should state pt was present in office with RN and whether the provider/patient interaction was audio only or audio/video. If audio/video, then 99202-99215 as telehealth. If audio only, then 99241-99243 as telephone. As @vinessachilders pointed out, IF it's a payor that accepts audio only for 99202-99215, then follow that payor's guidelines.
 
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