Navigate The Constantly Shifting Landscape Of Telemedicine Coding

With the use of telehealth on the rise, CMS loosens its grip on some geographic requirements

To keep you on your toes, the Centers for Medicaid & Medicare Services (CMS) changes the guidance to telemedicine and telehealth services almost every year. An extra challenge comes when technology changes every year, too – but at a pace faster than that of codes and their guidance.

To survive this rollercoaster, you need a thorough understanding of the basics, notes coding consultant Duane Abbey. In his AudioEducator webinar, “Telemedicine: Coding, Billing and Compliance for 2019,” Abbey covers a variety of topics, starting with the general concept of telemedicine and telehealth and how they work, and building on your knowledge from there.

Not Interchangeable: Telemedicine vs. Telehealth

Before going into the changes for 2019, make sure you nail down the difference between telemedicine and telehealth. If you’re using these terms interchangeably – don’t, as they describe slightly different concepts:

  • Telehealth: A broad scope of services that include non-clinical services such as remote provider training or administrative meetings.
  • Telemedicine: The “remote diagnosis/treatment of patients using telecommunications technology.

More limited in scope, telemedicine includes services such as:

  • Follow-up visits
  • Specialist consultations
  • Remote management of medication, chronic diseases, and/or post-hospitalization care

With advances in technology, providers can reach patients at their homes, assisted care facilities, work, or even school. No longer just for patients living in remote areas, telemedicine and telehealth can now also provide immediate care for routine or even minor but urgent conditions when needed.

CMS is Relaxing Geographic Requirements

Recognizing the advances in technology – which help cut down on telehealth costs – and its widespread use in medicine, CMS has begun relaxing some previously strict rules to reduce the burden for providers and patients.

Driven by the Bipartisan Budget Act of 2018 (BBA) which removed originating site restrictions, CMS followed suite in the CY 2019 Medicare Physician Fee Schedule (PFS). These loosened rules apply to those struggling with opioid addiction or suffering from end-stage renal disease or acute stroke.

Set to apply to services furnished on or after Jul. 1, 2019, these relaxed rules will help reduce the burden on both providers and patients. Those struggling with opioid addiction will now be able to use their home as an originating site – an update in line with the SUPPORT for Patients and Community Act. Patients struggling with end-stage renal disease can now benefit from monthly telehealth assessments from either their homes or renal dialysis centers, and mobile stroke units will count as originating sites for acute stroke patients.

Follow Telemedicine Reimbursement Rules: Traditionally driven by state laws, reimbursement can be the trickiest part of telemedicine coding. Since these changed guidelines apply strictly to originating sites, your overall reimbursement may not be affected, but pay close attention in case they do have an effect.

Telehealth Coding Adds 6 New CPT® Codes

In addition to changing guidelines, there are also new codes to reflect the expanding use of telemedicine and telehealth. New CPT® codes include four codes for remote monitoring and two for interprofessional internet consultation.

Remote monitoring of a wireless pulmonary artery pressure sensor – 93264

Remote monitoring of physiologic parameter(s), initial

  • 99453, set-up and patient education on use of equipment
  • 99454, device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

Remote physiologic monitoring treatment management services – 99457

Interprofessional telephone/internet/electronic health record (EHR) consultation

  • 99451, assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5+ minutes of consultative time
  • 99452, referral services provided by a treating/requesting physician or other qualified health care professional, 30 minutes

In addition, to support and code for the expanded acute stroke telehealth services mentioned above, CMS established modifier G0 (G zero).

Follow Accepted Guidance

As a general rule of thumb, work with providers to understand when telemedicine is appropriate, and when it isn’t. With the changing rules, it’s easy for everyone to be confused – from providers to payers – and payers may push back even after CMS policies are in place, says Duane Abbey.

In his webinar “Telemedicine: Coding, Billing and Compliance for 2019,” Abbey explains all the 2019 telemedicine reimbursement and coding changes – including changes in coverage and types of services that can be provided through telemedicine.

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