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Billing and Coding Considerations for Telehealth Services

The recent rise of telehealth services during COVID-19 led to the formation of new billing practices and codes. Furthermore, new rules and regulations came into the practice for the same. Keeping up with all of these changes is challenging, which is why most healthcare practitioners are outsourcing medical billing services and medical coding to third-party providers.

Challenges of Telehealth Services

Telemedicine and telehealth have been around for over a decade, or even more. However, due to the pandemic, its use saw a sharp incline in the last few years. This was mainly to address the barriers of in-person medical visits.
Furthermore, many new laws, regulations, and codes came into play for telehealth. Many of these are temporary and will go out of use after the end of the health crisis. However, keeping up with so many changes necessitates constant training and planning for the post-pandemic rollback of rules.
What is essential at the moment is having a robust billing/coding strategy, which can also work well in the future.

Recapitulating the Rise of Telehealth

Is it rollback time for telehealth? Not in the least! Telehealth saw a steep rise in overcoming and addressing the unique challenges of the pandemic. Now, clinicians can connect with patients in real-time through audio and video. It is all thanks to the wide range of digital health solutions – great alternatives to in-person visits. While the telehealth surge has worn off, it is not going anywhere! Telehealth services are appreciated by patients and sought-after by major medical organizations and practitioners alike.

Implications of Telehealth Services

The federal government also realizes the staying power of telemedicine/telehealth. At the same time, Medicare is expanding its telehealth coverage, all thanks to the recent policy changes. Equally important is that healthcare providers accurately code all of these telehealth.

Confusions in Telemedicine Codes

Telehealth continues transforming patient care; however, some implementation challenges lie, especially regarding medical coding and billing.
In response to the COVID-19 emergency, Medicare added over 100 CPT and HCPCS codes to the telehealth services list. Furthermore, understanding how to efficiently code telemedicine services has remained one of the biggest challenges for healthcare providers.
It is understandable with so many policy changes in a short time, in addition to the lack of experience in properly documenting the new services, the entire scenario is putting more stress on administrators.

Defining Telehealth Visits and Coding

The biggest issue providers face is defining telehealth visits and then coding them. Ideally, there are three types of virtual visits, and each comes with its unique associated codes:

  • Telehealth real-time:
    1. CPT codes 99211-5 for current patients
    2. CPT codes 99201-5 for new patients
  • E-Visits – Online Visits:
    1. CPT Codes 99421-99423
    2. HCPCS Codes G2061-G2063
  • Virtual Check-ins for determining need: HCPCS codes G2010 or G2012

Even on the basic level, the confusion levels for providers looking to code the claims correctly and submit them are astounding. Moreover, this is only the start.

Taking-On Challenges

There are over 100 telehealth codes, which can, however, change due to the waning effects of the global pandemic. Telehealth codes above are subject to change based on the method of communication. Furthermore, coders and billers must understand how every code can be applied. It is essential, as the use of the wrong codes can delay reimbursements.

There are three differences to take care of while documenting telehealth vs. in-person visits:

  • The telephone codes are essential for audio appointments, while the office codes are subject to audio or video telehealth visits.
  • Some other considerations apply to reimbursements, including a few state requirements making the real-time delivery of the services essential.
  • Medical coders need to learn the differences between the originating site and the distance sites for ensuring proper service coverage.

Final Word - Telehealth Services Aren’t Going Anywhere

While telehealth are commonplace and becoming increasingly familiar, these are still a new and upcoming segment of the US healthcare industry. The mechanisms of healthcare coding and medical billing continue to grow behind the scenes. In the face of such uncertainty and lack of experience, targeted expertise in telehealth services takes time to come by. Therefore, outsourcing telehealth coding and billing is becoming the norm among US medical practices.

Frequently Asked Questions

The codes are classified as follows:

  1. For Telephone E/M service for 5-10 minutes of discussion: 99441
  2. Telephone E/M services for 11-20 minutes of medical discussion” 99442
  3. For Telephone E/M services for 21-20 minutes of discussion: 99443

The use of communication technologies by medical practitioners for the delivery of healthcare services, including diagnostics and treatment – falls under telehealth.

As more and more practitioners turn to a third-party billing and coding provider, they are realizing it is less of an expense and more of an investment.