Telemedicine Services

SaritaJP21

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I have visits with appointment type : "Telemedicine 10 minute"

Here , Do we need to use modifier with E & M codes over here depending on the type of appointment ? If yes Which ?I mean as per my knowledge, 95 modifier with CPT code for commercial insurance plans, while the “GT” modifier must be included for Medicare and Medicaid plans is used. Request to guide the importance and requirement of these modifiers and effect on payment.

Chief Complaint
None recorded.
Vitals
None recorded.
Allergies
Allergies not reviewed (last reviewed 12/13/2018)
Medications
Medications not reviewed (last reviewed 12/13/2018)
Flucelvax Quad 2018-2019 60 mcg (15 mcg x 4)/0.5 mL IM suspension
12/08/18 filled MEDCO
predniSONE 50 mg tablet
10/26/18 filled MEDCO
Vaccines
None recorded.
Problems
Reviewed Problems
Family History
Family History not reviewed (last reviewed 12/13/2018)
Social History
Social History not reviewed (last reviewed 12/13/2018)
Smoking Status: Never smoker
Surgical History
Surgical History not reviewed (last reviewed 12/13/2018)
Appendectomy - 08/2001
Past Medical History
Past Medical History not reviewed (last reviewed 12/13/2018)
HPI
Pt here for 2nd visit to discuss condition and develop a relationship. We discussed the above and future use of medical marijuana.
ROS
ROS as noted in the HPI
Physical Exam
Patient is a 25-year-old male.

Constitutional: General Appearance: healthy-appearing, well-nourished, and well-developed. Level of Distress: NAD. Ambulation: ambulating normally.

Psychiatric: Insight: good judgement. Mental Status: active and alert and normal mood. Orientation: to time, place, and person.

Head: Head: normocephalic and atraumatic.

Eyes: Lids and Conjunctivae: non-injected and no discharge.

Neck: Neck: supple and trachea midline.

Skin: Inspection and palpation: no rash, lesions, ulcer, induration, nodules, jaundice, or abnormal nevi and good turgor.
Assessment / Plan
Pt here for followup visit. We discussed patient's future use of MMJ. We discussed the risks and benefits. Pt understands that we will certify patient, but the recommendation does not constitute a prescription for medical cannabis.

Pt here with below diagnosis - pt here for evaluation for their condition, evaluation of their medication use, and discussion for alternative treatments.

1. Multiple sclerosis
G35: Multiple sclerosis


Return to Office
None recorded.
 
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Hi,
Change Request (CR) 10152 eliminates the requirement to use the GT modifier (via interactive
audio and video telecommunications systems) on professional claims for telehealth services.
Use of the telehealth Place of Service (POS) Code 02 certifies that the service meets the
telehealth requirements
 

mitchellde

True Blue
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13,492
Location
Columbia, MO
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you should probably have as part of the documentation the location of the patient. The patient cannot be in their home or place of business. They must meet the definition of location by being physically in a physician office or clinic or hospital setting.
 
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you should probably have as part of the documentation the location of the patient. The patient cannot be in their home or place of business. They must meet the definition of location by being physically in a physician office or clinic or hospital setting.
that means we need to have the documentation such that it reflects that the patient was not there in the office when the call happened ? actually the progress note which is shown above is being received as telemedicine service.
 

mitchellde

True Blue
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Location
Columbia, MO
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No you should show where the patient is at the time of the service. The first telemedicine audit results showed that more than 50% of the reimbursements were recouped because the patient was located in their home when the telemedicine service took place. The telemedicine service should be documented as to where the service is originating from. Your physician is the distance provider. The patient must first be in a qualifying rural area and be located in a physician office or facility/clinic in order to begin the telemedicine to communicate to your provider at a distance location.
 

Laurenmlomax

Contributor
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FQHC Coding

No you should show where the patient is at the time of the service. The first telemedicine audit results showed that more than 50% of the reimbursements were recouped because the patient was located in their home when the telemedicine service took place. The telemedicine service should be documented as to where the service is originating from. Your physician is the distance provider. The patient must first be in a qualifying rural area and be located in a physician office or facility/clinic in order to begin the telemedicine to communicate to your provider at a distance location.
This was so helpful! I am new to FQHC's and my facility wants to implement telemedicine come Jan 1st, but I am not sure that they knew this information. I saw on the FQHC MLN booklet that we are authorized to serve as an originating site for telehealth services and that we can be paid an originating site fee. However we are not authorized to serve as a distant site for telehealth consultations.

Do you know if this rule applies to just telehealth consulations or all telehealth services?
 

mitchellde

True Blue
Messages
13,492
Location
Columbia, MO
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this is for all telehealth services. for the originating site you use the Q3014 code which has an approximate reimbursement of $24. Do not bill any other code for the originating fee.
Originating site:
An originating site is the location of an eligible beneficiary at the time the service furnished via a telecommunications system occurs. Beneficiaries are eligible for telehealth services only if they are presented from an originating site located in:
* A county outside of a Metropolitan Statistical Area
or
* A rural Health Professional Shortage area located in a rural census tract.

Beneficiary:
The beneficiary is located in a qualifying rural area ( you can check this using the Medicare Telehealth Payment Analyzer on the medicare website)
 

Laurenmlomax

Contributor
Messages
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FQHC - Telemedicine

this is for all telehealth services. for the originating site you use the Q3014 code which has an approximate reimbursement of $24. Do not bill any other code for the originating fee.
Originating site:
An originating site is the location of an eligible beneficiary at the time the service furnished via a telecommunications system occurs. Beneficiaries are eligible for telehealth services only if they are presented from an originating site located in:
* A county outside of a Metropolitan Statistical Area
or
* A rural Health Professional Shortage area located in a rural census tract.

Beneficiary:
The beneficiary is located in a qualifying rural area ( you can check this using the Medicare Telehealth Payment Analyzer on the medicare website)
Awesome thank you so much! If my FQHC has multiple sites, is it possible to have the distant site be under our FQHC at a separate facility and bill for the originating site for the facility the patient is at?
 

mitchellde

True Blue
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Columbia, MO
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possibly but the distant provider must meet certain requirements as well. You can look under Medicares website to get all of the particulars. In general think of it as the country mouse needs to have the expertise of the big city mouse doctor but they cannot travel the distance to the big city mouse pad.
 

SaritaJP21

Contributor
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possibly but the distant provider must meet certain requirements as well. You can look under Medicares website to get all of the particulars. In general think of it as the country mouse needs to have the expertise of the big city mouse doctor but they cannot travel the distance to the big city mouse pad.
Thanks for the guidance.:)
 

SHobbs

Networker
Messages
98
Location
Columbia
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other service

this is for all telehealth services. for the originating site you use the Q3014 code which has an approximate reimbursement of $24. Do not bill any other code for the originating fee.
Originating site:
An originating site is the location of an eligible beneficiary at the time the service furnished via a telecommunications system occurs. Beneficiaries are eligible for telehealth services only if they are presented from an originating site located in:
* A county outside of a Metropolitan Statistical Area
or
* A rural Health Professional Shortage area located in a rural census tract.

Beneficiary:
The beneficiary is located in a qualifying rural area ( you can check this using the Medicare Telehealth Payment Analyzer on the medicare website)
I know that we can charge the q3014 and bill to medicare. What do we do with the OV charge for the psychiatrist? any additional information would be extremely helpful. Thanks
 

mitchellde

True Blue
Messages
13,492
Location
Columbia, MO
Best answers
1
you would not be billing both. you are either the originating site or you are the distant site provider. The distant site provider will use the evaluation/counseling code with 02 POS. for Medicare you no longer use the GT modifier
 

SHobbs

Networker
Messages
98
Location
Columbia
Best answers
0
you would not be billing both. you are either the originating site or you are the distant site provider. The distant site provider will use the evaluation/counseling code with 02 POS. for Medicare you no longer use the GT modifier
oh goodness I don't know where my head is, thank you!
 
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