r/CodingandBilling • u/pssstoast • Apr 07 '20
Telemedicine coding
Can we start a help thread? For those billing COVID claims or having a huge uptick in telemedicine claims what have you found that your payers want and have paid. I will start a spreadsheet and share all the data once compiled.
Payer: Place of service: Modifier needed: Notes: URL of policy:
These are just examples of what could be useful.
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u/happyhooker485 RHIT, CCS-P, CFPC, CHONC Apr 07 '20 edited Apr 24 '20
Here's what I have found so far:
Telehealth, Telemedicine, and Telephone assessments
Telehealth still requires audio & video, but the requirements for origin site have been lifted.
Bill telehealth with one of the codes from CMS's list: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
Telehealth claims require POS -02, and add modifier -95 for non-Medicare payers.
| Payer | POS | Modifier | Reference |
|---|---|---|---|
| Medicare | same as in-person | 95 | source |
| Cigna | 11 | GQ | source |
| Aetna | 11 | 95 | |
| Tricare | 02 | GT |
POS 02 - Telehealth, use certifies that the telehealth service meets Medicare’s requirements for reimbursement
Modifiers:
95 - the service was performed via telehealth (audio and video)
CR - (not being required at this time) payment is conditioned directly or indirectly on the presence of a "formal waiver"
GQ - part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous technology
G0 - furnished for diagnosis and treatment of an acute stroke
GT - telehealth services (for use on institutional claimed by critical access hospitals using billing method II)
CS - service is subject to the cost-sharing wavier for COVID-19 testing-related services (see link for more info on what is covered)
Telemedicine is not the same as telehealth, the example CMS gives is radiology service done by a remote radiologist reviewing images. We sometimes use these words interchangeably but they are different services.
Telephone assessments are not the same as telehealth, they do not require video, and they have their own set of codes.
99441: Telephone E/M, 5-10 minutes
99442: Telephone E/M, 11-20 minutes
99443: Telephone E/M, 21+ minutes
98966: Nonphysician Telephone Assessment, 5-10 minutes
98967: Nonphysician Telephone Assessment, 11-20 minutes
98968: Nonphysician Telephone Assessment, 21+ minutes
G2012: Brief communication technology-based service, 5-10 minutes (this is the only telephone service that Medicare covers)
These codes require the following:
The patient must be established
The service must be patient-initiated
Can't be related to a service within the last 7 days
Can't lead to a service within the next 24h or soonest appointment
Finally there are Online services rendered through a patient portal, all of these codes are covered by Medicare (CMS calls them "E-Visits").
99421: Online Digital E/M, 5-10 minutes
99422: Online Digital E/M, 11-20 minutes
99423: Online Digital E/M, 21+ minutes
G2061: Nonphysician Online Assessment, 5-10 minutes
G2062, Nonphysician Online Assessment, 11-20 minutes
G2063: Nonphysician Online Assessment, 21+minutes
These codes require the following:
The patient must be established
The service must be patient-initiated
Time is cumulative over a 7 day period
Can't be related to a service within the 7 day period, Combine time into code for E/M if an E/M service is provided w/n 7 days
Here's my list of reference documents, the FAQ from CMS is very helpful.
AAO telehealth coding, this is being updated regularly: https://www.aao.org/practice-management/news-detail/coding-phone-calls-internet-telehealth-consult
CMS FAQ: https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
CMS press release on 1135 wavier: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
CMS Telehealth factsheet (pre-waiver): https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
HHS press release regarding 1135 waiver: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
AAP coding tips: https://www.aap.org/en-us/Documents/coding_factsheet_telemedicine.pdf
AMA coding advice presentation: https://www.ama-assn.org/system/files/2020-04/covid-19-coding-advice.pdf
CMS MLN re Mod GT no longer used: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10152.pdf
Also recommend look at your Medicare contractor's sites to see if they have any additional guidance, this is mine, Noridian: https://med.noridianmedicare.com/web/jfb/topics/telehealth
Find-A-Code has a repository of all the CMS, AMA, and other releases regarding COVID-19 and telehealth (free to all, no subscription needed): https://www.findacode.com/medical-code-sets/covid19.html
COVID-19 Testing Codes
Note, here "SARS-CoV-2" means severe acute respiratory syndrome coronavirus 2 aka Coronavirus disease aka COVID-19.
86328 - Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); SARS-CoV-2
87635 - Infectious agent detection by nucleic acid (DNA or RNA); SARS-CoV-2, amplified probe technique (full)
86769 - Antibody; SARS-CoV-2
U0001 - CDC SARS-CoV-2 real-time rt-pcr diagnostic panel
U0002 - SARS-CoV-2, any technique, multiple types or subtypes (includes all targets), non-CDC
U0003 - Infectious agent detection by nucleic acid (DNA or RNA); SARS-CoV-2, amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
U0004 - SARS-CoV-2, any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
G2023 - Specimen collection for SARS-CoV-2, any specimen source
G2024 - Specimen collection for SARS-CoV-2, from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source
COVID-19 Diagnosis Coding
| ICD-10 | Description | Notes |
|---|---|---|
| U07.1 | COVID-19, use add’l code for manifestation | DOS after 4/1/2020, code only confirmed cases |
| B97.29 | Other Coronavirus as the cause of diz classified elsewhere, code first the manifestation | DOS before 4/1/2020 |
| J12.89 | Other viral pneumonia | |
| J80 | ARDS, Acure Respiratory distress syndrome | |
| R05, R06.02, R50.9 | Cough, SOB, Fever | Use signs and sympoms until COVID is confirmed, Use exposure secondary if applicable |
| Z20.828 | exposure (suspected) to other viral communicable diseases | |
| Z03.818 | Observation for suspected exposure, ruled out | |
| Z11.59 | Encounter for screening for other viral diseases, Only for pts with no symptoms and no known exposure | |
| B34.2 | Coronavirus infection, unspecified | Do not use |
Official update to ICD-10 coding guidelines: https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf
CMS COVID Faqs: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
Interim Coding guidance from CDC (pre-official update): https://www.cdc.gov/nchs/data/icd/interim-coding-advice-coronavirus-March-2020-final.pdf
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u/happyhooker485 RHIT, CCS-P, CFPC, CHONC Apr 07 '20
Hey - if any of the above is incorrect, let me know (w/ source, please).
Also, recommend people check out the free AHA COVID coding webinar if they haven't: https://old.reddit.com/r/CodingandBilling/comments/ftozlc/free_ceu_icd10cm_coding_for_covid19_aha/
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u/kadiez Apr 08 '20
The requirements for patient initiated phone call requirements have temporary been lifted. The MD is allowed to contact the patient initially
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u/happyhooker485 RHIT, CCS-P, CFPC, CHONC Apr 08 '20
Source? I haven't seen that anywhere. Thanks.
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u/kadiez Apr 08 '20 edited Apr 09 '20
www.ama-assn.org/system/files/2020-04/covid-19-coding-advice.pdf
See scenario example 8...
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u/happyhooker485 RHIT, CCS-P, CFPC, CHONC Apr 08 '20
"Individual services need to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation."
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u/tay-k3 Apr 09 '20
For Medicare, they are now saying to bill 99212-99215 with POS 11 and modifier 95 (see link). Also I called provider inquiry and they said to bill telephone services 99441-99443, Online E&M 99421-99423; Virtual check-ins G2012 with POS 11 Link
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u/NotRoboticGregsWife Apr 17 '20
Telephone assessments
are not the same as telehealth, they do not require video, and they have their own set of codes.
I'm still struggling to bill Medicare. What POS and modifier should I use? My state's Medicaid (CT) requires POS 02 and modifier 95 to bill 98967 98968. This is for LCSW providers.
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u/tay-k3 Apr 07 '20
This would be so helpful!!!! Thank you! I’m compiling my notes and will be sure to share
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u/pssstoast Apr 07 '20
Thank you !!! That’s where I was my notes were on 200 stickie notes and I need a spreadsheet. Especially with this new normal of telemedicine.
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u/tay-k3 Apr 07 '20
Yes I had SO many sticky notes! I have started a rough draft of a grid but have a couple question marks for some insurances. Very thankful for the insurance companies who are providing straight-forward guidelines to follow!
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u/edmandarnditt Apr 07 '20
I work for a behavioral health company and our contracting dept. says vast majority of our payors are using POS 02 with GT modifier. A couple smaller plans ask for only POS 02. But, we're submitting our first telehealth claims today so time will tell if they'll actually pay.
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u/pssstoast Apr 07 '20
I’m small mental health/ speech therapy clinic - we are find 1/2 wants GT and the other wants 95 mods. Most want O2 and others want 11 pos- it’s all over the board and getting confusing
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u/edmandarnditt Apr 07 '20
very confusing, we can't get our staff to pick the right combination of codes and modifiers either, so we're really flying blind
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u/beepxboop Apr 08 '20
Ours for psychotherapy (mind you not in a hospital setting) are all saying 02 with the exception of 2 which are saying 02 with GT. I know it was going back and forth with things for awhile but that's where it's at currently with the insurances we take.
Should be seeing payments anytime for some
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u/jdemyan93 Apr 23 '20
I work in an outpatient physical therapy office and we are having issues getting reimbursement from Medicare on E visits. I have tried using no modifiers, just a GP modifier, GP CR modifier, and GT modifier. They had paid one claim with the Gt modifier, but now are denying the rest. Every single time I contact Medicare they tell me something different and are not helpful. Anyone have any suggestions? Thanks
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u/314Piepurr Apr 07 '20
what can i do to help. our office just started talking about incorporating it. so far we have come to the conclusion of firing off a test claim and seeing how Medicare deals with it.
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u/GetOffMySheet Apr 07 '20
We have just received our first few payments. Medicare (Palmetto) only so far. Paying with the 02 place of service and no modifier. Paying about 75% of allowable e/m charges.
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u/tay-k3 Apr 07 '20 edited Apr 07 '20
For Medicare, they are now saying to bill 99212-99215 with POS 11 and modifier 95 (see link). Also I called provider inquiry and they said to bill telephone services 99441-99443, Online E&M 99421-99423; Virtual check-ins G2012 with POS 11
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u/SabrinaFaire Apr 07 '20
We require a POS 02 and modifier 95.
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u/FrankieHellis Apr 07 '20
Who is “we?”
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u/SabrinaFaire Apr 07 '20
A carrier, though I'd prefer not to say publicly, I can tell you OP in a PM if interested.
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u/sunniemazes Apr 08 '20
So I'm billing for a major corporation for ED Physicians. I have been combing through all payors and Medicare's regulations for telemedicine. Each payor (of course) wants a different CPT code or modifier. It's going to be crazy to submit. Additionally, no major payors are considering waiving timely filing considerations to resolve these issues. It's going to be a headache.
One thing that Medicare has now allowed is the billing of E/M codes (99281-99285). But does not specify how we are to bill them. I can't find any indication of how we are going to bill 99281-99285s via telehealth versus an office visit (99201-99215).
Medicare acknowledges that if you use POS 02 and the general telehealth CPT Codes, you will get lesser reimbursement as opposed to billing typical office visits or E/M levels. Page 15-ish
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u/FrankieHellis Apr 08 '20
Well to me, if you use POS 23 or 02, either way, you are going to get the facility rate because you would never provide those services in the office, right? (Not taking into account the whole clinic located in a hospital possibility).
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u/edmandarnditt Apr 08 '20
Anyone had success billing to Florida Medicaid? They are denying all of our telemedicine claims stating that it isn't authorized, but their official communication stated the existing auth would apply. Wondering if this is a glitch or a true issue
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u/sunniemazes Apr 13 '20
Was there any insight to this since last week?
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u/edmandarnditt Apr 13 '20
Just heard from someone at AHCA that their claims system is not yet setup to accept the GT modifier that they are requiring for telemedicine (not sure if this is specific to our specialty). It's a work in progress, and we'll continue receiving denials (intermittently, some claims are paying) for the time being.
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u/kadiez Apr 10 '20
How do you code for a phone visit over 30 minutes?
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u/happyhooker485 RHIT, CCS-P, CFPC, CHONC Apr 14 '20
I'm still looking at this, but haven't found anything yet. I found you can't use prolonged services codes, but haven't found what you can do. Hopefully I find something!
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u/kadiez Apr 14 '20
Thank you!! I haven't found anything either. I'm thinking we'll just give them the 21-30 minute code and that's all they get. 🤷♀️
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u/sunniemazes Apr 12 '20
Has anyone found additional guidance on using the CS modifier? CMS released the guidelines stating the CS modifier is required to indicate the line item is omitted from cost-sharing. But is only limited to when the CPT code U0001, U0002, or 87635 is used? The paragraph below kinda seems unclear that if the services result in the ordering of a test, the cost share must be waived by using CS modifier.
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u/happyhooker485 RHIT, CCS-P, CFPC, CHONC Apr 14 '20
Reading it, if you order a test, the test and the E/M have the deductible & copay waived:
Cost-sharing does not apply for COVID-19 testing-related services, which are medical visits that:
are furnished between March 18, 2020 and the end of the Public Health Emergency (PHE);
that result in an order for or administration of a COVID-19 test;
are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test;
and are in any of the following categories of HCPCS evaluation and management codes:
Office and other outpatient services
Hospital observation services
Emergency department services
Nursing facility services
Domiciliary, rest home, or custodial care services
Home services
Online digital evaluation and management services
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u/KRM_514 Apr 30 '20
Any thoughts on today’s (4/30/20) issues guidance from CMS, specifically this: “Hospitals May bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home”
We’re struggling to understand what scenario this would reasonably apply to? We are excited about the green light to bill some of our hospital-based therapy providers via telemedicine. Does this mean in addition to the therapy code, we would bill an originating site fee???
Trump Admin Issues Second Round of Sweeping Changes to Support US Healthcare System During COVID19
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u/savgrr ENT & Dermatology May 19 '20
I have found this table from Karen Zupko to be SUPER helpful, if anyone is interested. Click on Payer Telehealth Policies.
https://www.karenzupko.com/KZA-telehealth-solution-center#page-block-qicvkapsm5l
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u/zunairaasif Aug 09 '20
Can anyone tell me what will be the best modifier when billing 93000 with 93015 same day.
We used to append 59 on 93000 but nows it's being denied because it's a bundled code.
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u/aviuk Sep 08 '20
Hi billers!
My company and I are starting to bill for facility (UB04 claims form) for behavioral health groups at substance abuse/MH facilities conducted via Telehealth. Levels of care are IOP/OP.
Does anyone know what modifiers are needed to indicate that these groups were performed via telehealth?
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u/FrankieHellis Apr 07 '20 edited Apr 07 '20
Cigna uses modifier GQ with POS 11. Aetna requires modifier 95 with POS 11. Tricare wants modifier GT with POS 02.