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Coding Corner: Telemedicine billing | David O. Holtz, MD

David O. Holtz, MD

The unprecedented impact of the COVID-19 situation has resulted in the need for clinicians to offer telemedicine services if established patients are unable to present to offices for appointments. CMS has established three (3) services/CPT codes below to capture and bill for these services. Please note these codes are to be used only for established patients, and there are specific requirements to bill these services that are provided immediately below the code descriptions.

To bill a telemedicine visit the following criteria must be met:

  • Telehealth visit cannot be related to a medical visit within the previous 7 days
  • Telehealth visit cannot be billed if an in person visit is going to happen within 24 hours
  • Patient must verbally consent and the consent must be documented in the medical record
  • Time spent speaking to the patient must be documented in the provider’s note
  • Patient is aware co-insurance and deductibles will apply
  • Billable for established patients only
  • Billable only by MD, DO, CRNP or PA

At my institution, we have been asked to use the following prescription prior to any telemedicine visit to avoid confusion by the patient if they are charged by their insurance companies after the fact:

You and I are about to have a telemedicine check-in or visit. This is allowed because you are already my patient, and you have requested it. This telemedicine visit will be billed to your health insurance or you, if you are self-insured. You understand you will be responsible for any copayments or coinsurances that apply to your telemedicine visit. Before starting our telemedicine visit, I am required to get your consent for this virtual check-in or visit by telemedicine. Do you consent?

CPT Code

Description

Work RVU

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 0.25
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 0.50
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 0.75

David O. Holtz, MD, is a gynecologic oncologist with Lankenau Hospital in Wynnewood, PA.

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