Coding

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