When the novel coronavirus pandemic confined people to their homes, telemedicine proved a practical way for physicians to interact with patients and improve access to care. Recognizing the value of telehealth in these challenging times, the Centers for Medicare and Medicaid (CMS) expanded covered telehealth services to include 135 different services and went on to make many telehealth flexibilities permanent. Many payers are also reimbursing chiropractic services provided via telehealth, though knowing state, local and payer rules is crucial to submit accurate claims. Relying on chiropractic billing services provided by an expert can ensure proper billing and reimbursement.

Chiropractic Telehealth Services

Telehealth encompasses video/audio communication between the health care provider and patient which can be real time or recorded for evaluation at a later time. Chiropractic telemedicine or telehealth includes different types of online consultations and electronic communications between chiropractors and patients:

Synchronous communication: This includes real time videoconferencing such as video consultation/video visit/video encounter or standard telephone calls where there is a “two-way audiovisual link between a patient and a care provider”, states the Office of the National Coordinator for Health Information Technology (ONC).

Asynchronous communication: Defined as “store-and-forward video-conferencing,” by the ONC, asynchronous telemedicine involves data transfer takes place over a period of time, rather than simultaneously (such as secure patient messaging, forwarding of imaging results).

Telerehabilitation: Provision of clinical rehabilitation services using telehealth technologies, covering a range of services from evaluation and diagnosis, through patient care management.

Physical manipulations such as adjustments can be performed only if the patient is present in the chiropractor’s office. Then what are the services that chiropractors can provide via telehealth? Doctors of chiropractic can use telemedicine for communicating with patients to:

  • Discuss symptoms
  • Prescribe exercises
  • Modify behaviours that may be worsening pain
  • Provide advice on self-management strategies that can be done at home
  • Assess patient’s progress
  • Provide follow-up treatment
  • Answer patients’ questions

Coding and Billing Chiropractic Services provided using Telehealth

Telemedicine CPT codes 99421-99423 can be used to bill services provided to established patients who have not had an in-office E/M service billed by the same provider within the same seven-day period (www.chiroeco.com). These telemedicine CPT codes are time-based should be billed as follows:

99421: Online digital E/M service for an established patient for up to seven days. Cumulative time: 5-10 minutes.
99422: Online digital E/M service for an established patient for up to seven days. Cumulative time: 11-20 minutes.
99423: Online digital E/M service for an established patient for up to seven days. Cumulative time: 21 or more minutes.

Telephonic E/M services (CPT codes 99441-99443) can be provided in cases where face-to-face visits may not be recommended, and it is medically appropriate for the patient to be evaluated and managed by telephone. However, telephonic services are to be provided only for the care of established patients or the legal guardian of an established patient.

Code “02” indicates that the E/M service was performed via telehealth. If the telemedicine visit is synchronous, modifier 95 should be appended to the code. However, it’s important to check payer rules as while some payers may prefer modifier 95, others may prefer modifier GT.

Telehealth services should be documented the same way as face-to-face services are documented. It should be stated that the service was provided non-face-to-face, and the patient’s location, the provider’s location, and the names and roles of anyone participating in the encounter should be included (www.aapc.com).

Like all medical billing, telehealth billing and reimbursement can be complex. Patients’ eligibility should be verified before the visit. Commercial insurance companies have different requirements billing telemedicine visits. Providers should ask payers about the CPT codes that can be used for telehealth billing. They should know specific payer telehealth policies and check with each payer before submitting claims to ensure compliance. Partnering with an experienced chiropractic billing company is the best way to ensure accurate claim submission and get paid promptly for telehealth services.