practice management

Coding FAQs for Telemedicine: Advice for Pediatricians

The first few weeks of a practice’s new telemedicine program often look similar: which vendor should you pick? How does it work? Who will perform telemedicine? Will my payers accept it? Once you’ve addressed these preliminary questions and gotten your first visits scheduled, it stands to follow that your next question will be: how will I be paid for telemedicine? From coding questions to government guidelines, here is (almost) everything you need to know to code and bill for telemedicine during the COVID-19 pandemic.

Disclaimer: The information shared below is from an April 7th, 2020 webinar by PCC’s coding expert, Jan Blanchard, CPC, CPEDC, CPMA,  for AAP’S Section on Administration and Practice Management (SOAPM). Jan gave her own advice which was accurate when the webinar was broadcast. Due to the shifting circumstances, some of the below information may change in coming weeks.

In turn, SOAPM has generously shared the webinar for you to view, even if you are not a member. Watch the webinar here and enter the password soapm_COVID-19.

Your Telemedicine Checklist

Have you done everything you need to do to get your new or revitalized telemedicine program running in a way that provides patients excellent care and gets your office paid? Here’s a primer.

  1. Do your research. This article and Jan’s webinar is a great start!
  2. Call your payers. For more information on what to ask for, see “Questions for Your Payers” below.
  3. Talk with your biller to make sure everyone is on the same page. Who will take responsibility if they are unable to work?
  4. Select a telemedicine vendor that your carriers accept and that works for your patients and office. Do a practice run. Do your patients need a refresher? Share with them this video to prepare for their first telemedicine visit!
  5. Establish communication with your staff and colleagues. Who will perform telemedicine? Will there be shifts? Where is it acceptable to perform these visits? Who will step up if a provider cannot make the appointment? Who has the appropriate skills to take on multiple roles to make scheduling more efficient?
  6. Be nimble. Stay up to date on the AMA’s latest announcements on their COVID-19 resource center and any changes your payers or state may implement as the pandemic progresses.
  7. Ask for help! Coding help is available to you via the AAP Coding Hotline and lots more AAP resources. Connect with your colleagues via forums such as the Business Impact of COVID-19 forum, hosted by the Pediatric Management Institute. PCC’s COVID-19 resource page is also updated frequently with the latest information.

Telemedicine Codes: Phone Call

First, we’ll cover codes for an established patient, parent, or guardian visit via a telephone call by a physician or other QHCP. These codes are accurate provided that the visit does not either originate from a previous visit within the last 7 days, nor leads to another within 24 hours or the soonest available.

99441: 5-10 minutes of medical discussion

99442: 11-20 minutes of medical discussion

99443: 21-30 minutes of medical discussion

Next, a telephone visit by a non-physician QHCP, for an established patient. This could be a dietician, physical therapist, or family counselor, but the clinician is typically not a physician.

98966: 5-10 minutes of medical discussion

98967: 11-20 minutes of medical discussion

98968: 21-30 minutes of medical discussion

FAQ: If I’m speaking to a patient on the phone and the call shifts to an audio/video call, which should I bill?

Jan recommends that you bill for this service the same way you would when treating a patient whose phone call resulted in a physical visit -- bill the latter.

Digital Care

Digital online care includes your portal and email messages. Codes are based on cumulative time spent for up to 7 days. This could mean messages sent across the portal or an email once in a week, or seven days in a week.

99421: 5-10 minutes

99422: 11-20 minutes

99423: 21 or more minutes

Remote Well Care

A well visit (New Patient 99381-99385, Established Patient 99391-99395) “might be billed with a modifier and/or a POS code to report that they were completed via interactive audio/video.”

Want more information on performing well visits via telemedicine? Check out this video from Lakeside Pediatrics’ Dr. Joe Hagan.

FAQ: What should I code for a real-time audio/video call with a patient?

The answer is: your regular E/M codes for a new or established patient, with the caveat that you should place a modifier or alternative Place of Service to indicate a televisit.

Reminder: Check with Your Carriers

Check with your payers before coding. Some carriers are accepting POS codes of 02 for telehealth services, while others require modifiers such as -95 (synchronous telemedicine service), -GT (via interactive audio/video services), or -CR (catastrophe or disaster related).

COVID-19 Specific Coding Resources

Lab codes for the 2019 novel coronavirus include the following:

87635: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

99000: Handling and/or conveyance of specimen for transfer from the office to a laboratory

FAQ: Do I need to code for state Medicaid requirements? What are they?

Yes, you should code for state-required Medicaid guidelines. Check with your state’s Medicaid program for details on what your state requires, and with the Center for Medicare and Medicaid Services where necessary.

Questions for your Payers

Jan stresses the importance of gaining clarify from each of your payers so that you can code and bill in a timely, informed manner. In her webinar, she covers a list of things to press:

  • Which telemedicine vendors will they accept?
  • Where can telemedicine be performed? (Some payers do not accept visits performed by a clinician outside the practice.)
  • When are relaxed rules, such as that between HIPAA and telemedicine via common platforms like Skype and Zoom, effective?
  • When was a public health emergency declared in your state?
  • When was it declared federally/nationally?
  • When do they currently have information the emergency will end?
  • What are their approved methods of remote delivery? Is audio/video okay or only audio?
  • What is covered? What is paid?
  • What is patient responsibility?
  • What is the encounter number limit?
  • Which codesets are defined?
  • Does your state allow new patients?
  • What qualifies as consent in your state and when should it be delivered? Verbal, documented, or both?

There’s a lot to take into account when it comes to coding correctly, but the effort is worth it. Practicing correct coding and updating your protocols regularly will ensure you’re paid correctly for the valuable work you always do, in a manner that protects kids, families, and your staff from unnecessary risk. How often should you reassess? Jan provides this final advice:

“This is an extraordinary circumstance. I expect much of the timing of changes to be controlled by outside forces. Deadlines and changes in status will depend on government mandates (Emergency declaration, e.g.). I'd offer advice that they stay abreast of announcement form regulators and watch their carrier bulletins and EOBs closely.”

Make sure to check out Jan’s complete webinar for more of her insights. Don't forget, the password to access the webinar is soapm_COVID-19.

SOAPM 'Fireside' Webinar: Telemedicine Services: Usage, Billing, & Coding During COVID-19

Allie Squires

Allie Squires is PCC's Marketing Content Writer and a transplant from upstate New York. She holds a master's in Professional Writing from NYU.