PrognoCIS Telemedicine Billing FAQ’s

Your frequently asked questions on PrognoCIS Telemedicine billing answered

Telemedicine Billing

FAQ's

While they must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility or hospital for the visit, effective for services starting March 6, 2020, and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.

99441: Telephone evaluation and management service by a physician or other qualified health care professional who
may report evaluation and management services provided to an established patient, parent, or guardian 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

99442: Telephone evaluation and management service by a physician or other qualified health care professional who
may report evaluation and management services provided to an established patient, parent, or guardian 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; 11-20 minutes of medical discussion

99443: Telephone evaluation and management service by a physician or other qualified health care professional who
may report evaluation and management services provided to an established patient, parent, or guardian 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; 21-30 minutes of medical discussion

Note, not all payers reimburse for this service

Medicare is covering G2012 for virtual check-in. Of note, Virtual check-in services can only be reported when the billing practice has an established relationship with the patient.

Yes, Medicare released a statement saying they will reimburse the same

The National Medicare rate is $12.27, but it does vary by state.

It depends on the payer. Follow the same guidelines as in person, i.e. Tricare does require referral and pre-auth

While they must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility or hospital for the visit, effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.

No, these codes are defined as an online communication via a portal, not interactive video

They could. I recommend only doing the POS to Medicare

Q3014 is the originating site fee. I pulled AL guidelines, they do not pay the originating site fee and they do require GT modifier with the E&M code

Procedure codes covered for telemedicine services include; consultations (99241-99245, 99251-99255), office or other outpatient visits (99201-99205, 99211-99215), individual psychotherapy (90832- 90838), psychiatric diagnostic (90791 – 90792), and neurobehavioral status exam (96116). All procedure codes billed for telemedicine services must be billed w ith modifiers GT (via interactive audio and video telecommunications system). The Agency will not reimburse providers for origination site or transmission fees.

With the covid19 lifts, yes their is a role for pain management, but check your medical board updates in regards to e-prescribing

If you are contracted with the payer, you can’t bill a patient directly for covered services.

No. These are not secure channels and the policy requires a secure channel. A Live audiovisual channel through a secure medical record (EMR) is allowed.

Use 99203-99204, with POS 02 and modifier 95 when a payer requires

It does not automatically go on progress note, you will have to document it or create a template with a start and stop time

While they must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility or hospital for the visit, effective for services starting March 6, 2020, and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.

New Codes for 2020:

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

Medicare lifted their regulations in light of COVID19 on 03/17/2020

As of 03/17/2020, yes Medicare is, they are not requiring modifier CR during this period

POS 02 And this also covers Zoom

This ultimately depends on what is being discussed. Typically this code is used when communicating with a patient to determine whether they should come in or not, but not to be used when doing med refills.

If you are using an interactive video it is regular E&M, the new codes are defined as: A communication between a patient and their provider through an online portal, it does not specify video

The provider receives recorded video and/or images remotely from a patient. He evaluates the material received, analyzes it, and interprets the findings and follows up with the patient within 24 hours. Report this code only if this service is performed unrelated to a previous E/M service within the past 7 days, and no related E/M service or procedure results from this service within the next 24 hours or next available appointment.

It depends on the payer as to which modifier they would like you to use. Please contact the payer for guidance.

99443 will not require modifiers

Each state will publish guidelines on if they are going to allow this, go to your state work comp site for updates on Telehealth

Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech-language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes: G2061-G2063

Yes normal E&M when using interactive video and audio. 99441-99443: “The seven-day period begins with the physician’s or other qualified health care professional’s (QHP) initial, personal review of the patient-generated inquiry. Physician’s or other QHP’s cumulative service time includes review of the initial inquiry, review of patient records or data pertinent to assessment of the patient’s problem, personal physician or other QHP interaction with clinical staff focused on the patient’s problem, development of management plans, including physician or other QHP generation of prescriptions or ordering of tests, and subsequent communication with the patient through online, telephone, email, or other digitally supported communication, which does not otherwise represent separately reported E/M service. https://codingintel.com/cpt-codes-online-digital-evaluation-and-management-services/

G0425-G0427 (Telehealth consultations, emergency department or inpatient). G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospital or SNFs) For Medicare.

Yes, the location is where the doctor is. Use POS 02 if utilizing telemedicine and they are at the office

Medicare only reimburses for chiropractic manipulation, and that cannot be performed via telemedicine. Other payers would have their own guidelines. We recommend you contact the payer for guidance.

Extend Quality Care with  PrognoCIS Telehealth Solution

Prognocis telemedicine and mobile apps enable providers to remotely access patient records, document hospital rounds and prescribe medication. Solutions scale from single physician clinics to large, multi-site and specialty medical facilities. Medical Practices can communicate seamlessly with radiology departments, labs, pharmacies, and other referring medical practitioners.

Other software features include:

  • Multiple data entry methods: point-and-click, voice and handwriting recognition
  • Scheduling management and health reminders E-prescription and lab automation
  • Compatibility with iPhone and iPad (Dragon Voice Recognition integrated into PrognoCIS Telemedicine mobile app)
  • HIPAA Compliant; CCHIT; HL-7 interfacing

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