Wiki Telehealth or Office?? HEELP

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esalcedo7151

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Hello,

I need urgent help, I have a scenario were the patient is going to the office for the E/M visit but the doctor is out of the office, the encounter between patient and provider is via telehealth. My question is what is the proper documentation and how are we suppose to report the CPT as a telehealth or F2F..all this is for PCP E/M visits
I hope I make sense and that somebody could help me.


Thank You,
 
I ALSO need urgent help with telemed. I have a scenario where the patient is going to the office for the E/M or counseling session but the doctor or counselor is either at home or in another office. We have multiple offices and the patient may be in one location in person, but the provider is in another office location or at home seeing the patient via telemed. My question is also what it the proper documentation and how are we supposed to report the CPT as a telemed visit? Use place of service 11 with no mod or with GT or 95 mod? Documentation should read patient presented in person to Hagertown, MD location and seen via telemed? This is for mental health and substance abuse. We need clarification on how to properly bill for this service and what the documentation should say. My thinking is we bill POS 11 with no mod since the patient was in the office and that the documentation should say patient at whatever office they go to and seen via telemed. I hope someone can help with this as soon as possible. Thanks in advance for any help anyone can provide on this matter.
 
Please check the Payer Policy for Telehealth visits. There is certain requirements regarding POS, modifiers and how the communication between member/provider was done (audio vs audio-video vs live interactive or other method) should be documented. LOB: C&S vs M&R vs E&I is also going to factor in to what is required, some Medicaid state specific rules may be required. For Medicare, here is a source, but there is more out there. https://www.cms.gov/files/document/mln901705-telehealth-services.pdf
 
as of today & until the end of this year MOST pandemic telehealth allowances are still in place. that means location is not an issue as they are still being processed as though thy were done in the office with the 95 modifier. best practice for these if your providers insist on doing them is provider in the office & pt at home. use caution if the provider is in another state- most likely they will need to be licensed in the state where the practice is located. there are many free webinars on this topic to get you started. go on youtube & search for "telehealth". there is a particularly informative one on there by the AMA.
 
lmichael969 said:
I ALSO need urgent help with telemed. I have a scenario where the patient is going to the office for the E/M or counseling session but the doctor or counselor is either at home or in another office. We have multiple offices and the patient may be in one location in person, but the provider is in another office location or at home seeing the patient via telemed. My question is also what it the proper documentation and how are we supposed to report the CPT as a telemed visit? Use place of service 11 with no mod or with GT or 95 mod? Documentation should read patient presented in person to Hagertown, MD location and seen via telemed? This is for mental health and substance abuse. We need clarification on how to properly bill for this service and what the documentation should say. My thinking is we bill POS 11 with no mod since the patient was in the office and that the documentation should say patient at whatever office they go to and seen via telemed. I hope someone can help with this as soon as possible. Thanks in advance for any help anyone can provide on this matter.
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Hi Neighbor!
Being from Maryland - we need to make sure the patient and provider are in the same state. IF the patient or provider are at home in PA or WV or VA then the provider needs to be credentialed to see patients in that state. The documentation that is required is just the provider stating (something along the lines of) "Today's visit was done via -insert platform you all use for telehealth visits (ex:doxy.me), OR by phone call- Patient aware of the limitations of the visit being done virtually." Like I said - something along those lines. The E/M code would definitely get a 95/GT mod. I think the POS code is based on where the patient is, physically. Also - The POS code will vary, depending on the insurance, sometimes.

I hope this helps.
 
esalcedo7151 said:
Hello,

I need urgent help, I have a scenario were the patient is going to the office for the E/M visit but the doctor is out of the office, the encounter between patient and provider is via telehealth. My question is what is the proper documentation and how are we suppose to report the CPT as a telehealth or F2F..all this is for PCP E/M visits
I hope I make sense and that somebody could help me.


Thank You,
Click to expand...
POS code is dependent on where the patient is, physically. Documentation needs to state that the patient agrees that it's ok to be seen virtually per whatever platform you all use (ex: doxy.me), or if it was audio-only. The E/M code gets a 95 or a GT modifier. I hope this helps a little!
 
For Medicare, until the end of the year, the POS is the one you would use if the visit had taken place in person. For example, if the patient would have come into the office for the visit, code POS 11.

Effective Jan. 1, 2024, you'll code 02 if the patient is not at home and 10 if the patient is at home. You will no longer use 95.
 
Hi, if you're asking whether the NP's visits can be reported incident-to: Based on what I understand of your question the MD owns the practice and employs the NP, but hasn't met any of the requirements for an incident-to service. So, no you can't.

As for billing the services of the NP incident-to as a workaround because the payer rejected their application: I think that is a bad idea and recommend against it. But you can always ask the payer.
 
perry_suzanne@ymail.com said:
Hi - I have a NP under a group practice that performs Telehealth for RPM and CCM services and also sees patients all visits are telehealth never face to face prior to RPM and CCM services for the first time with an E/M visit (not the MD) The MD that owns the practice and employs the NP is credentialed with a payer. NP is not credentialed with this payer. Billing has been done only with the NP under this group with all other payers including Medicare. This payer follows Medicare guidelines. (application was denied in 3/2023). MD has not billed under this group practice tax id (that the md owns) as a new patient or established patient that the NP is seeing. Billing incident to guideline? MD has seen the patient under one of his other group practices that he owns but it is not the same billing tax id for this group. I have never been in this billing situation and want to make sure documentation is there and this can be done. It does not seem right to me. Please advise on any suggestions of educational material to assist. Thank you!
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Agree with jkyles, from your description incident-to is not met for many reasons, but one is the fact that it is a different group practice. However, there are others. See the first link from NGS for everything that has to be met.
Maybe some of these will help:

"Can CCM services billed under CPT code 99491 be furnished “incident to” the billing practitioner’s services by other practitioners or clinical staff? No. As noted in the CY 2019 final rule (83 FR 59577), CPT code 99491 is specifically for use when the billing practitioner personally performs care management services, so this code cannot be furnished incident to a practitioner's professional services."
 
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