practice management

Telemedicine Billing Codes: Advice for Pediatricians

During the first few weeks of your practice’s new telemedicine program, the questions you’ll ask yourself are relatively standard: Which vendor should I pick? How does telemedicine work? Who will perform telemedicine? Will my payers accept it?

But once you’ve gone over those preliminary questions and gotten your first visits scheduled, it stands to follow that your next question will arguably be the most important: How will I be paid?

From coding questions to government guidelines, here is everything you may need to know to code and bill for telemedicine.

Your Telemedicine Checklist

Have you done everything you need to do to get your new or revitalized telemedicine program up and running? If you need tips on setting up your program to provide excellent care—while still getting your office paid—here’s a quick checklist.

  1. Do your research.
  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’re unable to work?
  4. Select a telemedicine vendor that your carriers accept and that works for your patients and office.
  5. Do a practice run. Do your patients need a refresher? Share this video with them to prepare for their first telemedicine visit!
  6. 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?
  7. 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.
  8. Don’t be afraid to 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 also frequently updates their COVID-19 resource page with the latest information.

Telemedicine Billing 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 telemedicine billing codes are accurate, provided that the visit does not either originate from a previous visit within the last 7 days or lead 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?

You should 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

doctor on laptopDigital online care includes your portal and email messages. Telemedicine billing codes involve the cumulative time spent for up to 7 days.

  • 99421: 5-10 minutes
  • 99422: 11-20 minutes
  • 99423: 21 or more minutes

 

Remote Well Care

A wellness 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?

You should input 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 COVID-19 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

It’s crucial that you gain clarity from each of your payers so that you can code and bill in a timely, informed manner. Here are a few things you should keep in mind.

  • Which telemedicine vendors will they accept?
  • Where can providers practice telemedicine? (Some payers do not accept visits from a clinician outside the practice.)
  • What are their approved methods of remote delivery? Is audio/video okay or only audio?
  • When are relaxed rules, such as that between HIPAA and telemedicine via common platforms like Skype and Zoom, effective?
  • Is there currently a public health emergency declared in your state?
  • What does insurance cover? What do they pay?
  • What is patient responsibility?
  • What is the encounter number limit?
  • Which telemedicine billing codes are there?
  • Does your state allow new patients?
  • What qualifies as consent in your state and how should they deliver it? 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 a smooth telemedicine billing process for the valuable work you do, in a manner that protects kids, families, and your staff from unnecessary risk. But how often should you reassess?

PCC’s coding expert, Jan Blanchard had this to say on the subject:

“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 [physicians] stay abreast of announcement form regulators and watch their carrier bulletins and EOBs closely.”

If you’d like to learn more about the ins and outs of telemedicine billing, check out Jan’s webinar through SOAPM. You can watch the entire webinar, even if you aren’t a member. Just make sure to enter the password soapm_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.