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.
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.
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).
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.
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.
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.
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.
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).
Lab codes for COVID-19 include the following:
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.
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.
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.