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.
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.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?
It would depend on if the telehealth is performed with Video or just by telephone.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.
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.)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.