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Coding Corner: Inpatient Consultations Via Telemedicine

With Sameer Sharma, MD, MBA, Society of Gynecologic Oncology (SGO) member and Director, Gynecologic Oncology at Northwest Cancer Center in Dyer, IN, and an Assistant Professor at Rush University in Chicago, IL.

Sameer Sharma, MD, MBA

Inpatient consultations via telemedicine can be used to substitute for a face-to-face encounter for initial and follow-up inpatient consultations, as well as for specialist consultations to discuss advice and recommendations physician-to-physician. These guidelines are constantly evolving during the COVID-19 public health emergency.

Initial Inpatient Consultations:

Medicare pays for reasonable and medically necessary inpatient telehealth consultation services furnished to beneficiaries in hospitals when your facility meets the following criteria for the use of a consultation code:

  • The physician of record or the attending physician requests the initial inpatient telehealth consultation for their patients located in the hospital or emergency room and documents this in the patient’s medical record.
  • A consultant or qualified health provider (QHP) needs to document the request for the inpatient telehealth consultation from an appropriate source and the need for an inpatient telehealth. The consultant then places this information in the patient’s medical record and lists the requesting physician.
  • The visit can be performed with audio/video two-way communication; many states will also allow audio alone two-way communication.
  • The consultant needs to prepare a written report of his/her findings and recommendations. Patient and QHP location should be listed in the record.
  • Typically, these services are reported as telehealth services when the individual QHP is not at the same location as the beneficiary but there are no apparent limitations to the QHP location.
  • The Medicare reimbursement for the consultation would include all related services furnished before, during, and after communicating with the patient via telehealth.
  • Teaching Physicians: Under the so-called primary care exception at section, a teaching physician may meet the requirement to review a visit furnished by a resident remotely using audio/video real time communications technology.

These services include, but are not limited to: 

  1. Reviewing the patient’s diagnostic imaging and lab work
  2. Communicating with other physicians or family
  3. Documenting the visit in the patient’s chart
  4. Discussing the results of the telemedicine consultation
  5. Developing further care plans

The following codes should be used for an initial inpatient telemedicine consultation:

Telehealth Code Typical Time wRVU
G0425 30 minutes 1.92
G0426 50 minutes 2.61
G0427 70 minutes 3.86

wRVU: work Relative Value Units

 

Follow-up Inpatient Consultations:

Telemedicine can be used to manage follow-up inpatient telehealth consultations furnished to patients in hospitals. These encounters can only occur after the patient’s initial consultation.

  • The visit can be performed with audio/video two-way communication; many states will also allow audio alone two-way.
  • The initial inpatient consultation can be provided as either as an in-person encounter or a telemedicine visit.
  • A subsequent inpatient visit can be furnished via Medicare telehealth, without the limitation that the telehealth visit is once every three days as per previous guidelines.

Follow-up inpatient telehealth consultations could include, but are not limited to, the following services: 

  1. Monitoring progress
  2. Suggesting management modifications
  3. Recommending a new plan of care based on changes in the patient’s status
  4. Coordinating care with other providers or agencies
  5. Communicating with other professionals
  6. Reviewing patient data
  7. Discussing the case with the patient’s family
  8. Completing medical records or other documentation
  9. Communicating the results of the consultation

The following codes should be used for a follow-up inpatient telemedicine consultation:

Telehealth Code Typical Time wRVU
G0406 15 minutes 0.76
G0407 25 minutes 1.39
G0408 35 minutes 2.00

wRVU: work Relative Value Units

Coding Q & A

Our Coding Task Force members are happy to answer your coding questions, but are unable to review individual operative reports.

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SGO members and professional coders may seek coding advice and recommendations by submitting the form.
Answers to incoming questions are provided by the members of the SGO Coding and Reimbursement Task Force and represent their opinion based upon the current and usual practices in the field. Every effort is made to ensure the accuracy of the information provided; however, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-10 CM code book; nor does it constitute legal advice. Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions.

SGO expressly disclaims all responsibility and liability arising from use of, or reliance upon this information as a reference source, and assumes no responsibility or liability for any claims that may result directly or indirectly from use of this information, including, but not limited to, claims of Medicare or insurance fraud.

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