Types of Virtual Services

Summary

Utilizing Telehealth Capabilities_- Uprise.pptx - PowerPoint

Telehealth Visits

  • Coding must reflect what was performed
    • Case History
    • Physical Exam
    • Medical Decision Making
  • Code level should be determined based on case history, physical exam, and medical decision making
  • Only with live, interactive 2-way telecommunications system  (e.g. real-time audio and video)
  • The waiver allows for telehealth services to be provided by optometrists using “everyday communications technologies”: such as FaceTime, Zoom, and Skype
  • Billing codes: 99201-99205, 99211-99215. Does not include 92002, 92012, 92004, 92014.
  • Modifier must be applied: 95 - Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunication systems

Remote Image/Video Evaluation

  • Initiated by an established patient
  • The image/video cannot be related to medical visit in previous 7 days and does not lead to medical visit in next 24 hours
  • The billing physician must follow-up with the patient within 24 hours to provider their interpretation and recommendations
  • Patient must give consent to services and consent must be documented in the medical record prior to service. Verbal consent is acceptable
  • Billing Code: HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.
  • At least one modifier MUST be applied:
    • Possible Modifiers:
      • GQ -Via asynchronous telecommunications systems
      • G0 (zero) - Telehealth services for diagnosis, evaluation, or treatment of symptoms of an acute stroke

Virtual Check-Ins

  • Requires an established relationship with the patient. 
  • Is not limited to only rural settings or certain locations.
  • Virtual check-ins can be conducted with a broader range of communication methods (telephone, video, image)
  • Billing Code: HCPCS code G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
  • At least one modifier MUST be applied:
    • Possible Modifiers
      • GT - Via interactive audio and video telecommunication systems
      • GQ - Via asynchronous telecommunications systems
      • G0 (zero) - Telehealth services for diagnosis, evaluation, or treatment of symptoms of an acute stroke

E-Visits (On-line digital evaluations)

  • Requires an established relationship with the patient. 
  • Is not limited to only rural settings or certain locations
  • Patients communicate with their doctors without going to the doctor’s office by using online patient portals.
  • Coninsurance and deductible apply, but can be waived during this time
  • Use Cases: Conjunctivitis, allergies
  • Billing codes:
    • 99421: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
    • 99422: Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes
    • 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.
  • At least one modifier MUST be applied:
    • Possible Modifiers
      • GT - Via interactive audio and video telecommunication systems
      • GQ - Via asynchronous telecommunications systems
      • G0 (zero) - Telehealth services for diagnosis, evaluation, or treatment of symptoms of an acute stroke

Telephone Services

  • Call results in decision to see the patient within 24 hours or next available urgent visit appointment
  • Call refers to E/M service billed by provider within previous 7 days whether requested by provider or not
  • Call is within postoperative period of completed procedure (part of post-operative service)
  • Reported 99441-99443 by same provider for same problem in previous 7 days
  • At least one modifier MUST be applied:
    • Possible Modifiers
    • GQ - Via asynchronous telecommunications systems
    • G0 (zero) - Telehealth services for diagnosis, evaluation, or treatment of symptoms of an acute stroke