Insights

Guide to COVID-19 Telehealth and Telemedicine


  • Please note a variety of effective dates have been referenced regarding the use of the code below specifically related to COVID-19. Therefore, the recommendation is to retroactive their use to March 6, 2020.

  • The provider must use an interactive audio and video telecommunications system that permits real-time communication between you at the distant site, and the beneficiary at the originating site.

  • Transmitting medical information to a physician or practitioner who reviews it later is permitted only in Alaska or Hawaii Federal telemedicine demonstration programs.

  • Best practice suggests that documentation should also include a statement of the method of telehealth service performed, consented from the patient to receive the services provided through telehealth, and both the location, names and roles of any person participating in the telehealth service (patient, provider, other).

    Recommendation:

    Audio & Video

    “ This service was provided through telehealth, audio & video. The patient has consented to proceed with this telehealth service. The patient located at

    ***( location of the patient ) and this writer located at***( location of the provider ) [if applicable - and the other parties of ***( names and roles of any other persons participating in the telehealth services )”

    Telephone Only

    This service was provided through telehealth, telephone only. The patient has consented to proceed with this telehealth service. The patient located at ***( location of the patient ) and this writer located at***( location of the provider ) [if applicable - and the other parties of ***( names and roles of any other persons participating in the telehealth services ) ]

     

CY 2020 Medicare Telehealth Services / Service

HCPCS/CPT Code

Medicare Telehealth Visits

Office or other outpatient visits

99201 – 99215

Telehealth consultations, emergency department or initial inpatient

G0425 – 30 min G0426 – 50 min G0427 – 70 min

Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs

G0406 – Limited, 15 min G0407 – Intermediate, 25 min G0408 – Complex, 35 min

Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)

99496

Advance Care Planning, 30 minutes

99497

Advance Care Planning, additional 30 minutes

99498

Psychoanalysis

90845

Family psychotherapy (without the patient present)

90846

Family psychotherapy (conjoint psychotherapy) (with patient present)

90847

Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient(could include caregiver/family) each 30 minutes; individual

patient

98960

Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4

patients

98961

Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8

patients

98962

Counseling visit to discuss need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making

G0296

Interactive Complexity Psychiatry Services and Procedures

90785

Health Risk Assessment

96160, 96161

Comprehensive assessment of and care planning for patients requiring chronic care management

(This is an add-on code to be used with another E/M service (the chronic care management initiating visit, which can be the AWV/IPPE or a qualifying face-to-face E/M visit)

G0506

Psychotherapy for crisis

90839, 90840

Office-Based treatment for opioid disorder

G2086 – 70 min in 1st month G2087 – 60 mins

G2088 – each add’l 30 min

Group psychotherapy

90853

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes

99457

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure)

99458

Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure)

90863

Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral

92227

Remote imaging for monitoring and management of active retinal disease (eg, diabetic retinopathy) with physician review, interpretation and report, unilateral orbilateral

92228

External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30

days; review and interpretation with report by a physician or other qualified health care professional

93228

External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care

professional

93229

External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, review and interpretation by a physician or other qualified health care professional

93268

External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, recording, and disconnection)

93270

External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended

monitoring; transmission and analysis

93271

External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional

93272

Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family

96040

Psychological testing evaluation - physician/QHP 1st hour

96130

Psychological testing evaluation - physician/QHP ea add’l hour

96131

Neuropsychological testing evaluation - physician/QHP 1st hour

96132

Neuropsychological testing evaluation - physician/QHP ea add’l hour

96133

Psychological or neuropsychological test administration and scoring, physician/QHP 1st 30 min

96136

Psychological or neuropsychological test administration and scoring, physician/QHP ea add’l 30 min

96137

Psychological or neuropsychological test administration and scoring, technician 1st 30 min

96138

Psychological or neuropsychological test administration and scoring, technician ea add’l 30 min

96139

Health behavioral assessment/reassessment

96156

Health behavioral intervention, individual 1st 30 min

96158

Health behavioral intervention, individual each add’l 15 min

96159

Health behavioral intervention, group 1st 30 min

96164

Health behavioral intervention, group ea add’l 15 min

96165

Health behavioral intervention, family 1st 30 min

96167

Health behavioral intervention, family ea add’l 15 min

96168

Speech/hearing therapy

92507

Evaluation of speech fluency

92521

Evaluation speech production

92522

Evaluation of speech sound production; with evaluation of language comprehension and expression

92523

Behavioral and qualitative analysis of voice and resonance

92524

Therapeutic exercises

97110

Neuromuscular reeducation

97112

Gait training therapy

97116

PT Eval low complex 20 min

97161

PT Eval mod complex 30 min

97162

PT Eval high complex 45 min

97163

PT re-eval est plan care

97164

OT eval low complex 30 min

97165

OT eval mod complex 45 min

97166

OT eval high complex 60 min

97167

OT re-eval est plan care

97168

Self care management training

97535

Physical Performance Test

97750

Assistive Technology Assess

97755

Orthotic mgmt&training 1st enc

97760

Prosthetic trainingg 1st enc

97761

Radiation treatment management, 5 treatments

77427

Reporting Contact Only

ICD-10

Contact with and (suspected) exposure to other viral communicable diseases should be reported if the patient has had contact with someone

who has tested positive, but the patient has no signs/symptoms.

Z20.828

Reporting Observation Only

ICD-10

Encounter for observation for suspected exposure to other biological agents ruled out should be used if the patient is being observed for what is thought to be COVID-19 but the test was negative, or it was ruled out. In this case it is important to code other signs/symptoms that the patient is experiencing.

Note: if another definitive diagnosis is reported instead, then that would take

the place of Z03.818.

Z03.818

Reporting a Confirmed Case

ICD-10

COVID-19 and Sequencing Guidelines After April 1, 2020

  • Code U07.1 COVID 19 as the PDX

  • Use additional code to identify pneumonia or other manifestations

  • Excludes1:

    • Coronavirus infection, unspecified site (B34.2)

    • Coronavirus as the cause of diseases classified to other chapters (B97.2) Severe acute respiratory syndrome [SARS], unspecified (J12.81)

Definitive Diagnosis

Before April 1, 2020

After April 1, 2020

With Pneumonia

If the pneumonia is confirmed as being due to a confirmed case of COVID-19, code:

J12.89, Other viral pneumonia

B97.29 Other coronavirus as the cause of diseases classified elsewhere

U07.1, COVID-19

J12.89, Other viral pneumonia

With Acute Bronchitis

If the bronchitis is confirmed as being due to a confirmed case of COVID-19, code:

J20.8 Acute bronchitis due to other specified organisms

B97.29 Other coronavirus as the cause of diseases classified elsewhere

U07.1, COVID-19

J20.8 Acute bronchitis due to other specified organisms

With Lower Respiratory Infection

If the lower respiratory infection is confirmed as being due to a confirmed case of COVID-19, code:

J22 Unspecified acute lower respiratory infection, not otherwise specified B97.29 Other coronavirus as the cause

of diseases classified elsewhere.

(Alternatively, if they state that it is another type of respiratory infection (not included in other coding options) then you would use J98.8 (other specified respiratory disorders) with

B97.29.

U07.1, COVID-19

J22 Unspecified acute lower respiratory infection, not otherwise specified

(Alternatively, if they state that it is another type of respiratory infection (not included in other coding options) then you would use J98.8 (other specified respiratory disorders)

With ARDS (Acute Respiratory Distress Syndrome) If patients with COVID-19 develops ARDS, code:

J80 Acute respiratory distress syndrome

B97.29 Other coronavirus as the cause of diseases classified elsewhere.

U07.1, COVID-19

J20.8 Acute bronchitis due to other specified organisms

Signs & Symptoms

For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive

diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: Cough, Shortness of breath, Fever, unspecified

R05 Cough

R06.02 Shortness of breath R50.9 Fever, unspecified

Modifiers (Note: May be needed for specific payers)

Modifier

CMS

Medicaid

Commercial

Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

(Note – Appendix P of AMA CPT book provides list of “CPT Codes That May Be Used for Synchronous Telemedicine Services”)

95

Yes

State Specific

Varies by payor

Via interactive audio and video telecommunication systems

GT

Telephone Only=Yes

State Specific

Varies by payor

State specific Modifiers indicating Telehealth services

U1 – UD

 

State Specific

Varies by payor

Catastrophe/disaster related (Professional)

CR

 

State Specific

Varies by payor

Place of Service (POS) Codes (Note Medicare, Ky Medicaid Use 02, Not Modifier GT)

     

POS codes are different by payor, by method that the services were provided; Audio & Video, Telephone Only Standard – use the typical POS code you would have provided to the patient were the visit have been normally face-to-face.

 

Audio & Video = AV
Telephone Only = T
Both = B

AV = Standard T = 02

State Specific

Varies by payor

Resources:

  • CMS Medicare Learning Network, Telehealth Services, MLN Booklet ICN 901705, January 2019

  • Centers for Disease Control (CDC) – “Coding guidance has been developed by CDC and approved by the four organizations that make up the Cooperating Parties: the National Center for Health Statistics, the American Health Information Management Association, the American Hospital Association, and the Centers for Medicare & Medicaid Services”. – for the ICD-10 information

State/

Professional Entity

 

Source

 

Notes

CMS

https://www.cms.gov/files/document/covid-final-ifc.pdf https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf

3/30/2020

Kentucky

https://kytelecare.med.uky.edu/kytelecare-ky-tele-health-network-policies

 

North Carolina

https://medicaid.ncdhhs.gov/blog/2020/03/13/special-bulletin-covid-19-2-general-guidance-and- policy-modifications

 

New Hampshire

https://www.nh.gov/insurance/legal/documents/nhid-order-health-insurer-coverage- coronavirus.pdf

 

Ohio

https://ohiohospitals.org/Health-Economics/Health-Policy/Telehealth

 

Maine

https://www11.anthem.com/shared/noapplication/f0/s0/t0/pw_g396592.pdf?refer=ahpmedprovider

Anthem Maine Health

Maine

https://www.maine.gov/sos/cec/rules/10/ch101.htm

Section 4 Telehealth Services

Virginia

http://www.vdh.virginia.gov/content/uploads/sites/13/2020/03/PPE-Recommendations_Shortage-Situations.pdf

 

Virginia

https://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3418.16/

 

Virginia

https://lis.virginia.gov/cgi-bin/legp604.exe?201+sum+HB1332S

 

American Academy of

Family Practice

https://www.aafp.org/journals/fpm/blogs/gettingpaid/entry/coronavirus_testing_telehealth.html

Legislation

NAMAS

https://namas.co/wp-content/uploads/2020/03/there-is-a-pandemic.pdf

 

These materials are for general informational purposes only. These materials do not, and are not intended to, constitute legal or compliance advice, and you should not act or refrain from acting based on any information provided in these materials. Please consult with your own legal counsel or compliance professional regards specific legal or compliance questions you have.

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