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Good Morning.
Does anyone have any case samples of codes 98966-98968 that they can share? for example-
What types of non physician providers (RNs eligible?) and what the phone call should consist of, beside time, to be eligible to bill it?
Thanks!
Codes and descriptors below-

Procedure code 98966: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

Procedure code 98967: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion

Procedure code 98968: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
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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!
 

kdlberg

Networker
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Casselberry, FL
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Medicare has released its guidelines. https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf. As far as payment goes, that depends on your MAC. In some states, the reimbursement for telemedicine is the same as if the code were provided face to face, but not all of them.

The private payers are, as usual, all over the place. If you go to the provider websites, they have a link off the landing page. I've checked Cigna, United, Aetna, and Florida Blue (though I'd imagine the other Blues are similar.) The only one that was not helpful was Humana. 3/4 of their "provider info" was "things to tell your patients to do" like social distancing, washing hands, etc. Yeah, great, I've got that. Tell me how to bill a freakin' virtual E/M. :rolleyes:
 

Tgarner2016

Contributor
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From what the cms.gov released, it states to bill the same office visit codes with a place of service 02. Does everyone else read that as well? This is such a huge change in what I do everyday and I want to make sure I am telling my staff the correct information. :)
 
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Brookings, OR
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does anyone have a link with this guidance? my "powers that be" want to see the guidelines and I just cannot find where CMS guides us to use the POS 02 or POS 11 and whether if you are using just telephone is it E/M codes or the 9941-99443, the link above does not tell us these things.
 

csperoni

Expert
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Selden
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The CMS FAQ link (previously provided by kdlberg), question 16 specifies if performing telehealth (which is interactive audio and visual) to use the same codes as usual with POS 02.
That is what I am encountering IN GENERAL with guidance from private payors as well.
Telephone only, there are CPT codes 99441-99443 for those services, or Medicare uses HCPCS code G2012.
does anyone have a link with this guidance? my "powers that be" want to see the guidelines and I just cannot find where CMS guides us to use the POS 02 or POS 11 and whether if you are using just telephone is it E/M codes or the 9941-99443, the link above does not tell us these things.
Medicare has released its guidelines. https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf. As far as payment goes, that depends on your MAC. In some states, the reimbursement for telemedicine is the same as if the code were provided face to face, but not all of them.

The private payers are, as usual, all over the place. If you go to the provider websites, they have a link off the landing page. I've checked Cigna, United, Aetna, and Florida Blue (though I'd imagine the other Blues are similar.) The only one that was not helpful was Humana. 3/4 of their "provider info" was "things to tell your patients to do" like social distancing, washing hands, etc. Yeah, great, I've got that. Tell me how to bill a freakin' virtual E/M. :rolleyes:
 

twdevore

Networker
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We're setting up our system to bill established codes 99211-99215 for telehealth. I'm searching for what documentation requirements we need to meet. I assume that the note will still need ROS and MDM elements as well as the time spent.

Anyone have any information?
Thank you!
Tim
 
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We are looking for verbiage for incident to and split shared for telemedicine.
Has anyone seen anything?
 

trarut

Expert
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Columbus, OH
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We're setting up our system to bill established codes 99211-99215 for telehealth. I'm searching for what documentation requirements we need to meet. I assume that the note will still need ROS and MDM elements as well as the time spent.

Anyone have any information?
Thank you!
Tim
A limited physical exam could still be possible depending on the specialty you're in so don't rule that out completely but yes, History and MDM elements will still need to documented and support the level billed if you are coding on content. The only mention I've found of documentation requirements is in an article from the MGMA, which I found here.

I would also be careful documenting time in the note if you aren't planning to bill on time. I've always been told once time is noted, all the other components go "out the window", whether you intend it that way or not.
 

taunmj

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Can someone explain in "dummy terms" how this Telehealth is supposed to be coded?? I work for a pulmonary/sleep medicine specialty clinic (in WI) and we use codes 99213-99215, 99203-99205 and 99243-99245, mostly. Which telehealth codes are for those CPT codes? If that makes sense? (Like, if a have an est patient that 'qualifies' for a 99214, which telehealth code would I use in place of that?)
 
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Can someone explain in "dummy terms" how this Telehealth is supposed to be coded?? I work for a pulmonary/sleep medicine specialty clinic (in WI) and we use codes 99213-99215, 99203-99205 and 99243-99245, mostly. Which telehealth codes are for those CPT codes? If that makes sense? (Like, if a have an est patient that 'qualifies' for a 99214, which telehealth code would I use in place of that?)
It would depend on if the telehealth is performed with Video or just by telephone.
If by telephone 99441-99443 and time must be documented.
If by video 99201-99215, 99241-99245
Below are links with guidance from the CMS.
https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
 

taunmj

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It would depend on if the telehealth is performed with Video or just by telephone.
If by telephone 99441-99443 and time must be documented.
If by video 99201-99215, 99241-99245
Below are links with guidance from the CMS.
https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf



If it was an est patient (99214) by phone, it would be 99441, 99442, or 99443, depending on the time??
 

csperoni

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Selden
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Yes. Telephone does NOT qualify as telehealth. Telehealth MUST be via interactive video and audio. Telephone only is 99441-99443 or virtual check-in G2012, depending on carrier.
 

kdlberg

Networker
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Casselberry, FL
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Yes. Telephone does NOT qualify as telehealth. Telehealth MUST be via interactive video and audio. Telephone only is 99441-99443 or virtual check-in G2012, depending on carrier.
And also, with the virtual check-in code, if the patient is then scheduled for a visit within 24 hours (or the next business day), then this code cannot be billed--you should be the E/M code for the visit. I believe it also has to be 7 days after a previous face-to-face visit with the same provider. (PCPs would have to follow-up with hospital discharges, and they should do that within the 7 day window.)
 
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