gcohen
Guru
Patient has telehealth visit, then is instructed to come to the office for COVID testing. Are you billing 99211 for the swab or just the prep and handling fee?
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Wiki Telehealth and COVID swab
- Thread starter gcohen
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pcapozzoli
Guest
I am looking that this information as well. We are presently billing 99211 but not the 99001, which I think we should be billing both??? If anyone knows apricate a little help. TKS
SharonCollachi
Guest
All of the advice to date says to bill the 99211 only if the patient only came in for the test.
If you have a telehealth visit and an in-person visit on the same day, I would think you would have to combine the work of both of them into one E&M code.
gcohen
Guru
gcohen
Guru
After further research, the AMA states you can bill the second E/M as it is a different place of service.
SharonCollachi
Guest
Well, that begs the question, just because you can, does that mean you SHOULD?
You allowed the patient to come in for a swab, but you didn't allow the patient to come in for an office visit. If it had been an office visit, you wouldn't be billing two office visits.
It just feels wrong.
I would note it is not a different POS on the claim form. Telehealth is billed POS 11 (or whatever the typical POS would be) during the public health emergency.
It does kind of feel like taking advantage of a loophole, but here's the AMA link.
Scenario 3 states exactly this situation. Bill the telehealth, and also 99211
I would suppose the rationale is that you might perform 20 telehealth, but only need 1 of those patients to come in for swabbing. You are preventing potential exposure to those other 19 patients. And when that 1 patient does come in, you are certainly incurring additional expenses.
It does kind of feel like taking advantage of a loophole, but here's the AMA link.
Scenario 3 states exactly this situation. Bill the telehealth, and also 99211
I would suppose the rationale is that you might perform 20 telehealth, but only need 1 of those patients to come in for swabbing. You are preventing potential exposure to those other 19 patients. And when that 1 patient does come in, you are certainly incurring additional expenses.
B_Rosenberg
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We are doing the swabs in a drive up scenario. We are billing only the 99211 and not the 87635. See attached from the AMA. I am not quite sure if we should be billing the 99000. Any advice?
99000 Handling and/or conveyance of specimen for transfer from the office to a laboratory
If you notice, the 99000 has "**" annotation with the explanation at the bottom of "Check with specific payor. Not covered by Medicare."
99000 is one of those codes that exist, but very few (if any) payors will pay separately for it. We are not taking COVID swabs in our office, but we do not use 99000 for other specimens. I think if you weren't getting paid for it for blood or other specimens, you will not get paid for COVID specimens.
If you notice, the 99000 has "**" annotation with the explanation at the bottom of "Check with specific payor. Not covered by Medicare."
99000 is one of those codes that exist, but very few (if any) payors will pay separately for it. We are not taking COVID swabs in our office, but we do not use 99000 for other specimens. I think if you weren't getting paid for it for blood or other specimens, you will not get paid for COVID specimens.
Just so I understand. Patient has a telehealth visit, then comes to the office for a swab. Bill the telehealth as well as 99211, on the same day, for the swab and only for the Covid.
If patient has telehealth visit and provider wants them to come to the office to have vitals taken, i.e. blood pressure/pulse. Or, if they show up to have flu or strep test done at the office would that change it to a regular E/M, even if they didn't see the provider when they came to the office?
If patient has telehealth visit and provider wants them to come to the office to have vitals taken, i.e. blood pressure/pulse. Or, if they show up to have flu or strep test done at the office would that change it to a regular E/M, even if they didn't see the provider when they came to the office?
Just so I understand. Patient has a telehealth visit, then comes to the office for a swab. Bill the telehealth as well as 99211, on the same day, for the swab and only for the Covid.
Per scenario 3 in the AMA advice, yes, bill the telehealth (-95) and the 99211. I don't necessarily agree, but that is the AMA advice.
If patient has telehealth visit and provider wants them to come to the office to have vitals taken, i.e. blood pressure/pulse.
This scenario is not specified in the AMA document, but I personally would bundle all the services into 1 E/M unless I found a reputable reference advising otherwise.
Or, if they show up to have flu or strep test done at the office would that change it to a regular E/M, even if they didn't see the provider when they came to the office?
Flu or strep have their own CPT codes and do not warrant an E/M. I would bill the telehealth (-95) and then on a separate claim for the testing done on site. If when they came on site, there was a medical need for additional evaluation by the clinician, I would bundle all the E/M services together and level. Again, this is not specifically addressed in the AMA document, but this is what I would do unless I found a contradicting reference.