Is it possible and easy to perform telemedicine coding during this Covid-19 pandemic? It’s confusing
to understand the telemedicine codes applicable for the services rendered. Though telemedicine is
booming in the current scenario, it’s very crucial and essential to learn about telemedicine coding
for quicker reimbursements.
The telemedicine coding and guidelines requires to be checked frequently to ensure healthcare
professionals have updated and accurate information. Being beforehand to check with insurance
companies regarding telemedicine coding guidelines can always save from denials and ensure revenue
payments on time.
Telemedicine Coding During Covid-19 Pandemic:
The announcement from the department of Health and Human Rights Services Office for Civil Rights
regarding the relaxed guidelines for the telemedicine services due to this Covid-19 has become a
soothing point for healthcare professionals and medical billing companies.
Office for Civil Rights has clearly stated that it won’t impose any penalties of non compliance with
requirements under Health Insurance portability and Accountability Act for healthcare professionals
depending on virtual assistants.
During this pandemic, telemedicine is considered as a real time interaction between healthcare
professionals and patient located far as well as remote.
It’s also evident that the communication exchanged by the healthcare professionals and patient
during the service or visit is synchronized and must meet the necessities of the services if
rendered with a face to face interaction.
CPT codes for Telemedicine and virtual E/M services:
The below mentioned telemedicine codes in CPT 2020 are used to report for telemedicine E/M services
performed by healthcare professionals.
These telemedicine codes are categorized as new and established patients under the E/M Subheading
office. Though used for typical E/M services, some of these codes can also be used for telemedicine
services.
Especially, these codes are also listed with * designation in order to show their importance.
New Patients’ Telemedicine Coding:
*99201: This code is used for office or other outpatient visit for E/M services of new patient. It
also requires three components such as a history focused on the problem, examination by focusing on
the problem and a direct medical decision making strategy.
*99202: This code is used for office or other outpatient visit for E/M services of new patient and
requires three key components such as expanded medical history targeting the problem, expanded
medical examination of the problem and straight forward decision making on the problem.
*99203: This code used for office or other outpatient visit for E/M services of new patient that
requires three key components especially, a detailed history, a detailed examination of the problem,
low complexity in medical decision making.
*99204: This code is used for office or other outpatient visit for E/M services of new patient which
actually requires three key components, they are: a comprehensive medical history of the problem, a
comprehensive medical examination of the problem and a moderate complexity in medical decision
making.
*99205: This code is used for office or other outpatient visit for E/M services of new patient which
requires three key components actually, they will be: a comprehensive medical history of the
problem, a comprehensive medical examination of the problem, and also a high complexity in medical
decision making.
Established Patients’ Telemedicine coding:
*99212: This code is used for office or other out patient visit for E/M services of an established
patient that requires at least any two of these key components that include: a medical history
focuses on problem, a medical examination focused on problem and straight forward medical decision
making.
*99213: This code is used for office or other outpatient visit for E/M services of an established
Patient which requires at least any two if these key components, they are: an expanded medical
history of the problem, an expanded medical examination of the problem and low complexity in medical
decision making.
*99214: This code is used for office and other outpatient visit for E/M services of an established
patient which requires at least any two of these three key components such as, a detailed history of
the problem, a detailed examination of the problem and also a moderate complexity in medical
decision making.
*99215: This code is used for office and other outpatient visit for E/M services of an established
patient that requires at least any two of these three key components such as, a comprehensive
medical history of a problem, a comprehensive examination of the problem and a high complexity in
medical decision making.
It’s important to keep in mind that Telemedicine coding requires the new or established patient CPT
codes 99241 to 99245 with all three key components to also include Modifier 95 while billing
telemedicine services.
Consultation Telemedicine coding for new and established patients:
*99241: This code is used for office consultation of new or established patients that requires three
main components such as, a medical history focused on problem, a medical examination focused on
problem and a straight forward decision making.
*99242: This code is used for office consultation of new or established patients which requires
three key components such as, an expanded medical history focuses on problem, an expanded
examination of the problem and straight forward medical decision making.
*99243: This code is used for office consultations of new or established patients which requires
three components such as, a detailed medical history of the problem, a detailed examination of the
problem and a low complexity in decision making.
*99244: This particular code is used for office consultation of new or established patients which
requires three components such as, a comprehensive medical history of the problem, a comprehensive
medical examination of the problem and a moderate complexity in decision making.
*99245: This code is used for office consultation of new or established patients that requires three
key components such as, a comprehensive medical history of the problem, a comprehensive medical
examination of the problem and a high complexity in decision making.
About GT Modifiers:
From last ten years, Medicare requires GT modifiers in order to clarify the way telemedicine
services are rendered. If it’s through an interactive video or audio, it has to be clearly stated.
Healthcare professionals are supposed to submit those claims for telehealth or telemedicine services
along with the GT modifiers attached to CPT codes.
Coding and billing telemedicine , GT modifier with a covered procedure must be mentioned by also
certifying that patient was present while performing telemedicine services.
It’s mainly an attempt by CMS to avoid complexities and confusions in paperwork while billing
telemedicine.
GT modifiers are being replaced by “Place of service “which should be mentioned on all revenue
payment services including virtual as well as office visits.
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