Wiki Telemedicine Skype Visits

[stockmandj@upmc.edu]

Our providers started doing skype calls as part of our telemedicine service. My question, when the patient is at home and the provider is in his/her office, do you need to provide the specific address of the provider's office on the claim to get reimbursed? We are a large academic practice and this service is expanding. If we need to provide the exact address, this could be a major build in our system of all the places of service. Does anyone have any information on the claim specs?

 

[mitchellde]

The difference is the 99421-99423 are for use when E/M services are performed, the type that would be done face-to-face, but instead are performed through a HIPAA compliant secure platform. These are for patient-initiated communications, and may be billed by clinicians who may independently bill an E/M service. They may not be used for work done by clinical staff or for clinicians who do not have E/M services in their scope of practice.
These are not scheduled in advance and follow the same rules as the telephone calls with respect to timing. There is no restriction on where the patient may be located at the time of the service.
telemedicine on the other hand has restrictions as to where the patient is located and wherethe provider is located. The patient must be in an approved originating site and that does not include their home or place of business. And the provider must a qualifying distant site provider It is billed using the 02 POS and no modifier for Medicare, the 95 modifier is for some commercial carriers. These may be scheduled encounters

 

[mitchellde]

You cannot bill telemedicine if the patient is in their home. Home is not an approved originating site for Medicare and all payers that follow Medicare guidelines. Any other payer will need to provide specific requirements as to whether home is an allowable POS.

 

[mitchellde]

There is an excellent and lengthy explanation of the 99421-99423 codes in the CPT book, I really suggest you read that. As for Patient initiated, that means the patient contacts the office requesting to speak with or communicate with the provider. There are timing rules involved that are also explained in the CPT book and the patient must be established. These are not the same as telemedicine as explained earlier. I suggest you read the book and then if you have questions we can explore it further.