The Basics of Medical Coding for Telehealth Visits

Posted by admin | October 23, 2017 , (0) comments








Advanced communication technology is revolutionizing the way healthcare is provided. One of the most significant advances in the last decade is telemedicine, which refers to a broad range of remotely-provided medical services. One such service is telehealth visits, through which physicians provide care for patients in remote offices. This can be especially helpful for patients who live in rural areas where only an advanced practice registered nurse (APRN) or physician assistant (PA) is available to provide service. With a telehealth visit, it is possible for the local provider and the patient to consult with a physician (MD) through an audio- or video-based telecommunications system. Using technology in this way presents exciting opportunities in the practice of medicine, but it can also significantly complicate medical coding.

For most telehealth visits, you need to follow the same coding standards as you would for any patient appointment — with a few caveats. You use the same CPT and/or HPCS codes, but you must add a modifier.

CPT and HPCS Codes for Telehealth Visits

As with any other visit CPT and HPCS codes you need to submit on a claim for telehealth services vary widely. Some of CPT codes you might need include.

A) CPT codes 99201 – 99215: Office or other outpatient visits. For most telehealth visits, you will use one of these codes. Of these, the most common are 99203 and 99213.

B) CPT codes 99231 – 99233: Subsequent hospital care services. When using these codes, note that there is a limit of one telehealth visit every three days.

C) CPT codes 96150 – 96154: Individual and group health and behavior assessment and intervention. These codes are commonly used by psychiatrists who provide telehealth visits for underserved areas where mental health services are not widely available.

Many of the HPCS codes are the same as those that you would use for a face-to-face visit. However, it is important to note that some of them are telehealth-specific, including the following:

D) HPCS codes G0425 – G0427: Telehealth consultations, emergency department or initial patient

E) HPCS code G0459: Telehealth pharmacologic management

Essential Modifiers for Telehealth Visits

When submitting a claim with any of these CPT codes for telehealth visit, you must add one of two modifiers: either GT or GQ.

A) The modifier GT is used to modify CPT codes indicating the provision of professional services “via interactive audio and video telecommunications systems.”

B) The modifier QT is used when billing a federal payer for telehealth services provided in Alaska or Hawaii as part of federal telemedicine demonstration programs, in which services are provided “ via an asynchronous telecommunications system. ”

If physicians at your practice regularly provide telehealth visits to patients in remote locations, you may want to consider outsourcing your medical coding to the experts at AnnexMed. That way, your staff won’t have to deal with the added complexities of medical coding for telehealth visits. Contact us today to learn more about the services we offer!


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