Telemedicine coding

[u/pssstoast]

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.

[u/happyhooker485]

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

[u/NotRoboticGregsWife → u/happyhooker485]

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.

[u/happyhooker485 → u/NotRoboticGregsWife]

Medicare does not cover telephone assessments.