Wiki Telehealth, asyncronous "store and forward"

[Love Coding!]

Hi all,

I hope someone can send me some guidance on my dilemma please read below:

I have searched and searched for billing guidelines for asynchronous 'store and forward', which does NOT fall under the telemedicine definition but rather telehealth. Let me explain my dilemma.

We have an Optho department that reviews images sent to a shared data bank. The optho doc does not see the patient in "live time" the patient is in a hospital with the "spoke" apart from the "HUB" provider. Images were taken of the patient, the results are entered into this databank and the consulting provider goes in and reviews the images and then reports back to the "spoke" provider.

My optho docs feel that they can bill an "E/M" code for this service. Our patients are primarily Medicaid (AHCCCS). How is this possible when an E/M is a "face to face" encounter? I understand the E/M codes can be billed when there is a live interaction (telemedicine) exchange between the spoke and the hub with the GT modifier. But what billing codes should they be using along with the GQ modifier (via asynchronous telecommunications systems)?

Any advice is greatly appreciated

 

[thomas7331]

Here's a link to a good reference publication from CMS on telehealth (link below). Per this document (see page 4 and page 9), to bill telehealth services "you must use an interactive audio and video telecommunications system that permits real-time communication between you, at the distant site, and the beneficiary, at the originating site. Asynchronous “store and forward” technology, the transmission of medical information the physician or practitioner at the distant site reviews at a later time, is permitted only in Federal telemedicine demonstration programs in Alaska or Hawaii" - so as I understand it, the GQ modifier is only eligible for payment if your physicians are providing services to those sites originating in AK or HI. If that's the case, you would bill the telehealth service that most accurately represents the service documented, even though it is not actually face-to-face in this situation due to the technology. If your main payer is AHCCCS, I'm assuming these are not patients in AK or HI, but I'd recommend perhaps reviewing their payer-specific policies or contacting them as it's possible they may allow an exception to the CMS guidelines in certain cases.

https://www.cms.gov/Outreach-and-Ed...NProducts/downloads/TelehealthSrvcsfctsht.pdf