Wiki Telecommunication Billing

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NicoleSprecher

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I am wondering if anyone has any guidance or recommendation on billing virtual telecommunication visits?
How to bill (codes, modifiers, ect...)?
Payer reimbursement?
Any information would help!

Thanks in advance for any information!
 
Nicole.Sprecher@phci.org said:
I am wondering if anyone has any guidance or recommendation on billing virtual telecommunication visits?
How to bill (codes, modifiers, ect...)?
Payer reimbursement?
Any information would help!

Thanks in advance for any information!
Click to expand...
You would bill out same codes you use for OV (99201-99215) with modifier 95 for commercial insurance and POS is 02. Reimbursement should be the same as what you get for same service in office. This is what we sent out to our providers

DOCUMENTATION:

Patient must give consent to be treated virtually and it must be documented in the medical record before the service is initiated. Patient should present a picture id to verify identity. Documentation should include the service that was provided, location of both the patient and provider and all the persons participating in the telehealth service.

Progress notes will be documented as soap notes. No physical examination will be documented. Diagnosis selection will remain the same. Make sure you have a strong HPI and plan. This will provide medical necessity that is needed for the visit. Time will need to be documented in the note. New patients will be billed out based on time spent.
 
I work in an outpatient mental health clinic, can anyone give any guidance in how to bill phone (audio only) sessions such as CPT code, modifier (if needed) and POS? Does anyone know if these codes are being covered by insurances during the COVID 19?

Any insight on this topic would greatly be appreciated!
Thank you and stay safe and stay healthy!
 
Any specific info available addressing a Provider providing telehealth services from their home instead of at practice location? I'm having a hard time finding supporting documentation for this and how to determine what service location should be billed on encounters if this is allowed (we have two practice locations).
 
pattywhilhite@fmclp.com said:
You would bill out same codes you use for OV (99201-99215) with modifier 95 for commercial insurance and POS is 02. Reimbursement should be the same as what you get for same service in office. This is what we sent out to our providers

DOCUMENTATION:

Patient must give consent to be treated virtually and it must be documented in the medical record before the service is initiated. Patient should present a picture id to verify identity. Documentation should include the service that was provided, location of both the patient and provider and all the persons participating in the telehealth service.

Progress notes will be documented as soap notes. No physical examination will be documented. Diagnosis selection will remain the same. Make sure you have a strong HPI and plan. This will provide medical necessity that is needed for the visit. Time will need to be documented in the note. New patients will be billed out based on time spent.
Click to expand...
 
Per Cigna Representative they want the E&M telehealth codes and billed the the regular face to face place of service, so if 11, you still bill 11 and they want the GQ modifier. So far, that is the only major Carrier that I have seen a difference in billing.
 
Hi Patricia! Most of our payers are requiring a 02 POS for telehealth. My question is in regards to service location selected on these claims when the provider is conducting the telehealth visits from their home.
 
Jtolleson said:
Hi Patricia! Most of our payers are requiring a 02 POS for telehealth. My question is in regards to service location selected on these claims when the provider is conducting the telehealth visits from their home.
Click to expand...
NGS Medicare advised in their webinar last week if the provider is located at home, you would still indicate the office address. If you have multiple offices, I would pick whichever the provider is usually at, or it you have a "main" office, use that. The specific question of multiple offices was not asked during the webinar.
 
Has anyone heard anything about the possible use of after hours codes in conjunction w/telehealth codes if the telehealth visit is, indeed, conducted after our normal business hours and all guidelines are met? Thank you.
 
I'm not sure if this will help but I received this by email.

March 24 2020​

COVID19 Resources​

The coding and documentation experts of our collective companies (TrustHCS, RevCycle+, Visionary RCM, and T System) have compiled the following resources for you regarding COVID-19. As you work to maintain coding operations and proper documentation amid this health crisis, please feel free to use:


A Complementary COVID-19 Documentation Set from T System at:
https://www.tsystem.com/pages/news-events/press-releases/client-services/complimentary-influenza-t-sheets.php


Compiled General Coding Tips Related to COVID-19 at:
https://trusthcs.com/coronavirus/


Tips on Coding Telehealth During COVID-19 at:
https://trusthcs.com/coronavirus-telehealth/


COVID-19 Coding Question Submission Form:
https://trusthcs.com/coronavirusquestions/


In addition, the experts who helped generate these content pieces are making themselves available on Wednesday, March 25th at 3:00 PM Central (4:00 PM Eastern, 1:00 PM Pacific) for a LIVE question and answer session. If you can make this session and have questions for this team, please register for the session at the link below:


LIVE Q&A REGISTRATION LINK:
https://attendee.gotowebinar.com/register/2916792548417022477


As always, please let us know if you have any areas where we can be of service during this trying time.


TrustHCS
www.TrustHCS.com
info@TrustHCS.com



​
 
I have called Medicare twice for confirmation about telehealth (audio & visual) AND telephone (audio only) services and I was told that during the public health emergency of COVID19 that BOTH telehealth and telephone services would be covered and that we would bill as you would as if patient was seen face to face: regular CPT codes, POS 11 and modifier 95. Has anyone confirmed with Medicare about phone sessions?? I have called on 2 separate occasions and spoke with 2 different people but am still nervous about billing that way.
 
Yes, Medicare is covering both telehealth and telephone encounters currently, but they are not billed the same way. I have seen several people misunderstanding the fact that Medicare will cover telephone encounters to be interpreted as audio only should be billed with E/M codes.
Telehealth (video and audio) are 99201-99215 POS 11 (or whatever POS you would typically use). Modifier -95
Telephone are G2012 or 99441-99443 POS 11. No modifier per Novitas Medicare webinar today.
I think the situation was that CMS revised their guidelines and re-worded to mean that if you are using a telephone with VIDEO and audio, that is billed E/M - ie smart mobile phone with internet vs landline. That re-wording and revision made some people interpret that telephone with VIDEO is the same as telephone with audio only, and it is not.
I hope that helps explain it a little better.
 
Thank you for your response, but that is not what I have been told by Medicare. I actually called and spoke to CSR's about this and I was told to bill it the way I described above....regular CPT codes (because that is what we normally bill if it weren't for the public health emergency), POS 11 (because that is normally where our services take place) and modifier 95. The modifier allows them to know it was done telehealth but we use POS 11 so we get reimbursed at our regular rates.
 
That is not what I was instructed, or in anything I have read. The 03/30/2020 update included POS specified to bill where you would normally with -95 and that telephone encounters are covered. I have not heard/read anything to state the CPT should be what you would normally bill.
I am attaching the slides from the Novitas Medicare presentation today. Specifically, page 17:
"Individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services:
• Providers can evaluate beneficiaries who have audio phones only using the new telephone services codes"
The telephone info starts on page 36 specifying 99441-99443 for physicians.
This clearly states telephone encounter is covered, but to bill using telephone encounters 99441-99443.
Remember, this is all CMS guidance and your private carriers may have different policies.
 

Attachments

  • Explore Telehealth Services Part AB 04092020Final.pdf
    301.3 KB · Views: 26
I specifically asked about the codes and verified the codes we bill (99214/90833, etc or 90837 etc) and they said to bill those codes for both audio AND telehealth. I guess I have no idea
 
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