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  • Coding for Telemedicine

    Effective January 1, 2022

    What Is Telemedicine?

    Telemedicine is defined as the remote diagnosis and treatment of patients by means of telecommunications technology. The terms telemedicine and telehealth are interchangeable. 

    Regulatory Requirements

    • Telemedicine rules apply to new and established patients.
    • Patients must be notified that a claim will be submitted to the payer.
    • Deductibles, co-payments and any remaining balances according to the remittance advice should be collected.
    • HIPAA compliant platforms must be in place.
      • Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.

    What Office Based CPT Codes Qualify for Telemedicine?

    Telemedicine codes are identified by a star in front of the CPT code in the American Medical Association 2022 CPT book or the Academy’s 2022 CPT: Complete Pocket Ophthalmic Reference. Here is a link to Center of Medicare & Medicaid Services list of telehealth services that include Eye Visit Codes.

    The appropriate level of E/M office-based codes will be determined by either medical decision making or physician time on the date of the encounter.

    New Patient 99202 99203 99204 99205
    Established Patient 99211* 99212 99213 99214 99215

    *Additional notes regarding CPT code 99211:
    • A documented order from the physician is required indicating what should be addressed during the staff/patient encounter.
    • Supervision may be virtual.
    • All testing services are bundled with 99211.
    • CPT code 99211 and any other level of E/M is not payable on the same day.
    • The physician must sign the medical record.

    Telemedicine Phone Calls

    99441 Telephone evaluation and management services by a physician or other qualified health care professional (nurse practitioner (NP) or physician assistant (PA) 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 not leading to an E/M service or procedure within the next 24 hours or soonest available appointment: 5-10 minutes of medical discussion
    99442 11-20 minutes of medical discussion
    99443 21-30 minutes of medical discussion

    Out-of-Office Locations for Telemedicine

    Subsequent Hospital Care 99231 99232 99233
    Inpatient Consultations 99251 99252 99253 99254 99255
    Subsequent Nursing Facility Care 99307 99308 99209 99310

    Modifier Application

    The modifier conveying to the payer the exam is performed via telemedicine can vary by payer. Please check each individual payers’ website.

    The Centers for Medicare and Medicaid Services (CMS) published a new modifier effective January 1, 2022. It is modifier -93 Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system.

    Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional (nurse practitioner (NP) or physician assistant (PA) and a patient who is located away at a distant site from the physician or other qualified health care professional. The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

    Modifier -93 must be appended to applicable exam codes indicating to Medicare Part B that the exam was performed via audio only telemedicine.

    Hybrid Exams

    Telemedicine options improve patient capacity by reducing in-office schedules due to social distancing requirements and requests. Histories taken by phone and drive-up IOP checks are the new normal for many practices. Along with offering telemedicine appointments for minor conditions, expanding the encounter to include recent testing services may increase treatment options. Consider the following telemedicine hybrid scenarios:

    Scenario #1: A 70-year female schedules a follow-up for nonexudative age-related macular degeneration.
    • Staff obtains and documents history in the medical record.
    • The patient is COVID-19 high-risk for severe illness; a telemedicine hybrid appointment is offered based on the clinic scheduling protocol.
    • The physician reviews the chart and assesses the previous exam, visual acuity and findings.
    • A retina OCT is ordered and documented in the medical record.
    • The patient is scheduled for a visual acuity and OCT at the satellite office closest to her home.
    • A subsequent telemedicine appointment with the ophthalmologist is scheduled at the next convenient date and time.
    • At the satellite office, a technician tests visual acuity and conducts an OCT clinic, scheduled 30 minutes apart for social distancing. There is no wait for the patient and additional time is allotted for sanitation between tests.
    • During the telemedicine appointment, the physician reviews the history, visual acuity, and OCT, discusses the findings and provides recommendations to the patient.
    Scenario #2: A 62-year old male is recalled for a 4-month glaucoma check.
    • After reviewing the patient’s chart and previous visual field and glaucoma OCT, the physician considers telemedicine options due to the lack of availability for a timely clinic appointment.
    • The patient is scheduled for an IOP check at the next available drive-up clinic, with a follow-up telemedicine appointment with the physician.
    • The follow-up telemedicine encounter is conducted. The physician reviews the IOP, discusses current medications and findings, and provides recommendations to the patient.

    When utilizing telemedicine hybrid encounters consider the following:
    • Physicians should direct the scheduling of telemedicine hybrid encounters based on patient-specific criteria or a comprehensive clinical scheduling protocol.
    • All delegated testing services require a physician order that is documented prior to the encounter.
    • Patients must verbally consent to the telemedicine encounter.