Consumer demand, changes in reimbursement, and technological advancements are the main factors driving the popularity of telemedicine or virtual medical care. Telemedicine has transformed healthcare, allowing patients to get the treatment they need without leaving their homes. Providers can communicate with patients anywhere and anytime, track their health status, and provide timely interventions. With new remote patient monitoring codes taking effect January 1, 2019, medical coding outsourcing is a practical option for providers to ensure proper reimbursement for telemedicine services or e-consults.

E-consults – Key Takeaways

Telemedicine is recognized or its ability to significantly reduce the cost of treating health conditions as well as risk of readmissions. Telehealth improves care in family practices in many ways. It is also a great option for dermatology, orthopedics, behavioral health and cardiology allowing specialists and hospitals to improve care management and care coordination for underserved communities and the elderly. Telemedicine has proved useful for monitoring chronic conditions such as diabetes and coronary disease, and treating allergies, arthritis, respiratory infections, colds, flu and fever, skin rashes, bladder infections, etc. The American Medical Association is pushing for more telehealth and mHealth in Diabetes Prevention Programs, which use group counseling and one-to-one coaching to improve health and wellness for those at risk of developing type 2 diabetes.

Telemedicine consultations can be of great help when natural disaster strikes. EMS World recently reported on how Lifeguard Ambulance Service used ambulances outfitted with the telemedicine system to serve patients in areas affected by Hurricane Michael that struck Mexico Beach, Florida in October 2018. Telemedicine allowed medical officers to complete assessments and treatments in the patient’s residence that would otherwise need transport to the hospital.

Implementing Telemedicine

Implementing virtual medical care in a primary care practice would involve various steps such as selecting a suitable telemedicine platform, training staff, setting up the equipment, ensuring proper tech support, and informing and educating patients on e-visits. Once the telemedicine platform is set up, the consulting process would be relatively straightforward, especially when the need for specialist care is involved:

  • The primary care physician (PCP) will upload the patient case on the online portal, also providing data such as images or test results.
  • The specialist will be alerted via a text message about the availability of the evisit in the platform. After reviewing the case and making a diagnosis, the information will be sent back to the PCP.
  • With the response received from the specialist on the patient’s concerns, the PCP can treat the patient effectively. The patient would not need to set up an appointment with the specialist.

Telemedicine Coding

Understanding the state’s telemedicine policy and payer guidelines and determining the practice’s telemedicine billing policy is crucial to get paid for services rendered. Providers need to also know which codes to use to bill telemedicine. Commonly used office or other outpatient evaluation and management (E/M) codes for telemedicine include:

  • 99201 – 99205 New patient visits
  • 99212 – 99215 Established patient visits
  • 99241 – 99245 Consultation codes
  • 99406 – 99408 Behavioral change intervention codes

There are also many codes for Medicare Fee-For-Service Providers such as:

  • HCPCS codes G0425 – G0427 Telehealth consultations, emergency department or initial inpatient HCPCS codes
  • HCPCS codes G0406 – G0408 Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs
  • CPT codes 96150 – 96154 Individual and group health and behavior assessment and intervention
  • CPT codes 90832 – 90834 and 90836–90838Individual psychotherapy
  • HCPCS code G0459Telehealth Pharmacologic Management

New Codes in 2019

In 2019, there are new opportunities to get paid for remote healthcare services. Three new CPT codes for Chronic Care Remote Physiologic Monitoring have been introduced, which experts consider a “landmark change” in government efforts to embrace telehealth and mHealth (mhealthintelligence.com). The three new remote patient monitoring codes reflect how health professionals can make better use of technology to connect more efficiently with their patients at home to gather data for care management and coordination. The new CPT codes are:

  • 99453 Remote monitoring of physiologic parameter(s), (for example, weight, blood pressure, pulse oximetry, respiratory flow rate) initial; setup and patient education on equipment use.
  • 99454 Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
  • 99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

Billing Telemedicine – Points to Note

The American Academy of Pediatrics (AAP) offers the following recommendations for billing telemedicine services:

  • Time: Documentation for the encounter should include the required elements for each CPT code has required elements, such as key components or time. As time can be monitored automatically through an electronic encounter, it may be easy document total time spent in counseling and/or coordination of care in the patient record. Only the provider’s face-to-face time with the patient/caregiver is counted toward the level of service provided.
  • The video component required for telemedicine encounters can be billed using a standard CPT code with the 95 modifier.
  • Inclusion of assessments using peripherals such as thermometers, oxygen saturation monitors, spirometers, blood pressure monitors, glucose monitors, etc. in the documentation will support the need for a certain number of required elements for the CPT code being used.
  • Qualifying services also have to be “synchronous,” i.e., they have to be real-time, interactive visits between a patient/family and a clinician.
  • In the “asynchronous” category (for e.g., emails, radiograph and ultrasound studies) clinical information is supplied and considered at a later time. These do not qualify for the process of using the 95 modifier.
  • Effective January 1, 2018, POS 02 is to be used for all telehealth services under Medicare.
  • Before submitting claims, providers should check their state’s rules and payer policies on coverage for telemedicine services.

Studies have reported that remote patient monitoring has a positive impact on patients as it allows them to share data real time with their physicians, leading to more individualized care and enhanced health outcomes. Medicare has expanded telemedicine services eligible for payment in 2019. Partnering with an experienced medical billing company can help providers take advantage of these new opportunities as they focus on enhancing patient reach.