Wiki Telehealth in an Inpatient Setting

[NHBilling2019]

I am billing for a physician in the hospital. We bill professional claims. My question is this: Do we use 95 modifier with pos 21? I have been told we CANNOT. If not, how do we indicate it is a telehealth visit for a patient that is in the hospital?

 

[csperoni]

Where are you seeing information that you cannot?

The CMS guidance is to add -95 for telehealth and use the POS you would have used during the PHE.
On their FAQ, section P question 5 and question 13 both answer this question as use -95.
5. Question: How does a health care provider bill for telehealth services?
Answer: The IFC directs physicians and practitioners who bill for Medicare telehealth services to report the place of service (POS) code that would have been reported had the service been furnished in person. This will allow our systems to make appropriate payment for services furnished via Medicare telehealth which, if not for the PHE for the COVID-19 pandemic, would have been furnished in person, at the same rate they would have been paid if the services were furnished in person. We believe this interim change will maintain overall relativity under the PFS for similar services and eliminate potential financial deterrents to the clinically appropriate use of telehealth. During the PHE, the CPT telehealth modifier, modifier 95, should be applied to claim lines that describe services furnished via telehealth. Practitioners should continue to bill these services using the CMS-
1500/837P.
13. Question: Will CMS require specific modifiers to be applied to the existing codes?
Answer: For telehealth services furnished during the PHE, CMS is allowing practitioners to use the POS code that they would have otherwise reported had the service been furnished in person. To identify these services as Medicare telehealth, CMS is requiring that modifier 95 be appended to the claim.

Some private payors are making their own rules. If this is a rule from the carrier, you should follow their guidance.

 

[csperoni]

I just wanted to add - you state "billing for a physician in the hospital." If the physician and the patient are both physically located at the hospital, even if the provider is using video (for example COVID+ patient and trying to reduce number of providers coming into contact with patient), this is not telehealth. That scenario is billed as in person. This is in section P, question 9 of the CMS FAQ referenced above.

 

[NHBilling2019]

Where are you seeing information that you cannot?

The CMS guidance is to add -95 for telehealth and use the POS you would have used during the PHE.
On their FAQ, section P question 5 and question 13 both answer this question as use -95.
5. Question: How does a health care provider bill for telehealth services?
Answer: The IFC directs physicians and practitioners who bill for Medicare telehealth services to report the place of service (POS) code that would have been reported had the service been furnished in person. This will allow our systems to make appropriate payment for services furnished via Medicare telehealth which, if not for the PHE for the COVID-19 pandemic, would have been furnished in person, at the same rate they would have been paid if the services were furnished in person. We believe this interim change will maintain overall relativity under the PFS for similar services and eliminate potential financial deterrents to the clinically appropriate use of telehealth. During the PHE, the CPT telehealth modifier, modifier 95, should be applied to claim lines that describe services furnished via telehealth. Practitioners should continue to bill these services using the CMS-
1500/837P.
13. Question: Will CMS require specific modifiers to be applied to the existing codes?
Answer: For telehealth services furnished during the PHE, CMS is allowing practitioners to use the POS code that they would have otherwise reported had the service been furnished in person. To identify these services as Medicare telehealth, CMS is requiring that modifier 95 be appended to the claim.

Some private payors are making their own rules. If this is a rule from the carrier, you should follow their guidance.

2. Question: Can hospitals and other institutional providers bill for telehealth services that are furnished by certain practitioners? Answer: In general, no. While a hospital may bill for certain “remote services” furnished in a provider based department (which may include the patient’s home during the COVID-19 PHE), hospitals and other institutional providers are not generally permitted to bill for telehealth services.

The provider is a specialist. I submit professional claims for him - So, it sounds like since it is a professional claim, we should be able to bill with the 95 modifier?

 

[csperoni]

2. Question: Can hospitals and other institutional providers bill for telehealth services that are furnished by certain practitioners? Answer: In general, no. While a hospital may bill for certain “remote services” furnished in a provider based department (which may include the patient’s home during the COVID-19 PHE), hospitals and other institutional providers are not generally permitted to bill for telehealth services.

The provider is a specialist. I submit professional claims for him - So, it sounds like since it is a professional claim, we should be able to bill with the 95 modifier?

Correct, you bill with -95 for telehealth during the PHE per CMS guidance. The question/answer you listed specifies hospitals and institutional providers (SNF, hospice, HHA, etc.), therefore does not apply to your services.