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TeleHealth and You

Coding


TeleHealth and You

Date Posted: Monday, July 10, 2017

 

Before we can go any further, let's familiarize ourselves with some important definitions.
 
What is an authorized originating site? 

- A facility meets the criteria if it does not fall within a metropolitan statistical area OR has an address that falls in a metropolitan statistical area, it must be in a rural area and a in a geographic Health Professional Shortage Area (HPSA)
What implications does HPSA have? 

- HPSAs are designated by HRSA (Health Resources & Services Administration) as having shortages of mental health, dental care or primary within geographic (county or service area), population (low income or Medicaid eligible), or facilities (state or federal prisons, federally-qualified health centers). http://www.telehealthresourcecenter.org/who-your-trc

What is covered by Telehealth?

CY 2016
COVERED TELEHEALTH SERVICES
 
CY 2017
COVERED TELEHEALTH SERVICES
Code
90791
90792
90832
90833
90834
90836
90837
90838
90845
90846
90847
90951
90952
90954
90955
90957
90958
90960
90961
90963
90964
90965
90966
96116
96150
96151
96152
96153
96154
97802
97803
97804
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99231
99232
99233
99307
99308
99309
99310
99354
99355
99356
99357
99406
99407
99495
99496
G0108
G0109
G0270
G0396
G0397
G0406
G0407
G0408
G0420
G0421
G0425
G0426
G0427
G0436
G0437
G0438
G0439
G0442
G0443
G0444
G0445
G0446
G0447
G0459

Short Descriptor
Psych diagnostic evaluation
Psych diag eval w/med srvcs
Psytx pt&/family 30 minutes
Psytx pt&/fam w/e&m 30 min
Psytx pt&/family 45 minutes
Psytx pt&/fam w/e&m 45 min
Psytx pt&/family 60 minutes
Psytx pt&/fam w/e&m 60 min
Psychoanalysis
Family psytx w/o patient
Family psytx w/patient
Esrd serv 4 visits p mo <2yr
Esrd serv 2-3 vsts p mo <2yr
Esrd serv 4 vsts p mo 2-11
Esrd srv 2-3 vsts p mo 2-11
Esrd srv 4 vsts p mo 12-19
Esrd srv 2-3 vsts p mo 12-19
Esrd srv 4 visits p mo 20+
Esrd srv 2-3 vsts p mo 20+
Esrd home pt serv p mo <2yrs
Esrd home pt serv p mo 2-11
Esrd home pt serv p mo 12-19
Esrd home pt serv p mo 20+
Neurobehavioral status exam
Assess hlth/behave init
Assess hlth/behave subseq
Intervene hlth/behave indiv
Intervene hlth/behave group
Interv hlth/behav fam w/pt
Medical nutrition indiv in
Med nutrition indiv subseq
Medical nutrition group
Office/outpatient visit new
Office/outpatient visit new
Office/outpatient visit new
Office/outpatient visit new
Office/outpatient visit new
Office/outpatient visit est
Office/outpatient visit est
Office/outpatient visit est
Office/outpatient visit est
Office/outpatient visit est
Subsequent hospital care
Subsequent hospital care
Subsequent hospital care
Nursing fac care subseq
Nursing fac care subseq
Nursing fac care subseq
Nursing fac care subseq
Prolonged service office
Prolonged service office
Prolonged service inpatient
Prolonged service inpatient
Behav chng smoking 3-10 min
Behav chng smoking > 10 min
Trans care mgmt 14 day disch
Trans care mgmt 7 day disch
Diab manage trn per indiv
Diab manage trn ind/group
Mnt subs tx for change dx
Alcohol/subs interv 15-30mn
Alcohol/subs interv >30 min
Inpt/tele follow up 15
Inpt/tele follow up 25
Inpt/tele follow up 35
Ed svc ckd ind per session
Ed svc ckd grp per session
Inpt/ed teleconsult30
Inpt/ed teleconsult50
Inpt/ed teleconsult70
Tobacco-use counsel 3-10 min
Tobacco-use counsel>10min
Ppps, initial visit
Ppps, subseq visit
Annual alcohol screen 15 min
Brief alcohol misuse counsel
Depression screen annual
High inten beh couns std 30m
Intens behave ther cardio dx
Behavior counsel obesity 15m
Telehealth inpt pharm mgmt
  Code
90791
90792
90832
90833
90834
90836
90837
90838
90845
90846
90847
90951
90952
90954
90955
90957
90958
90960
90961
90963
90964
90965
90966
90967
90968
90969
90970
96116
96150
96151
96152
96153
96154
97802
97803
97804
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99231
99232
99233
99307
99308
99309
99310
99354
99355
99356
99357
99406
99407
99495
99496
99497
99498
G0108
G0109
G0270
G0396
G0397
G0406
G0407
G0408
G0420
G0421
G0425
G0426
G0427
G0438
G0439
G0442
G0443
G0444
G0445
G0446
G0447
G0459
G0508
G0509
Short Descriptor
Psych diagnostic evaluation
Psych diag eval w/med srvcs
Psytx pt&/family 30 minutes
Psytx pt&/fam w/e&m 30 min
Psytx pt&/family 45 minutes
Psytx pt&/fam w/e&m 45 min
Psytx pt&/family 60 minutes
Psytx pt&/fam w/e&m 60 min
Psychoanalysis
Family psytx w/o patient
Family psytx w/patient
Esrd serv 4 visits p mo <2yr
Esrd serv 2-3 vsts p mo <2yr
Esrd serv 4 vsts p mo 2-11
Esrd srv 2-3 vsts p mo 2-11
Esrd srv 4 vsts p mo 12-19
Esrd srv 2-3 vsts p mo 12-19
Esrd srv 4 visits p mo 20+
Esrd srv 2-3 vsts p mo 20+
Esrd home pt serv p mo <2yrs
Esrd home pt serv p mo 2-11
Esrd home pt serv p mo 12-19
Esrd home pt serv p mo 20+
Esrd home pt serv p day <2
Esrd home pt serv p day 2-11
Esrd home pt serv p day 12-19
Esrd home pt serv p day 20+
Neurobehavioral status exam
Assess hlth/behave init
Assess hlth/behave subseq
Intervene hlth/behave indiv
Intervene hlth/behave group
Interv hlth/behav fam w/pt
Medical nutrition indiv in
Med nutrition indiv subseq
Medical nutrition group
Office/outpatient visit new
Office/outpatient visit new
Office/outpatient visit new
Office/outpatient visit new
Office/outpatient visit new
Office/outpatient visit est
Office/outpatient visit est
Office/outpatient visit est
Office/outpatient visit est
Office/outpatient visit est
Subsequent hospital care
Subsequent hospital care
Subsequent hospital care
Nursing fac care subseq
Nursing fac care subseq
Nursing fac care subseq
Nursing fac care subseq
Prolonged service office
Prolonged service office
Prolonged service inpatient
Prolonged service inpatient
Behav chng smoking 3-10 min
Behav chng smoking > 10 min
Trans care mgmt 14 day disch
Trans care mgmt 7 day disch
Advncd care plan 30 min
Advncd are plan addl 30 min
Diab manage trn per indiv
Diab manage trn ind/group
Mnt subs tx for change dx
Alcohol/subs interv 15-30mn
Alcohol/subs interv >30 min
Inpt/tele follow up 15
Inpt/tele follow up 25
Inpt/tele follow up 35
Ed svc ckd ind per session
Ed svc ckd grp per session
Inpt/ed teleconsult30
Inpt/ed teleconsult50
Inpt/ed teleconsult70
Ppps, initial visit
Ppps, subseq visit
Annual alcohol screen 15 min
Brief alcohol misuse counsel
Depression screen annual
High inten beh couns std 30m
Intens behave ther cardio dx
Behavior counsel obesity 15m
Telehealth inpt pharm mgmt
Telehealt con initial ccare
Telehealt con subseq ccare

This information is based on Medicare Physician Fee Schedule. In a side-by-side comparison, there are some slight changes between the 2016 and 2017 lists.  Any additions are contingent upon Medicare's determination that services are safe, medically beneficial or effective. Consequently any deletions mean they have been deemed unsafe, unbeneficial or ineffective. Requests for changes can be submitted and will be reviewed. 

There are two Categories for submission of requests for Medicare for Telehealth Services:

  • Category 1: Services that are similar to professional consultations, office visits, and office psychiatry services that are currently on the list of telehealth services.  In reviewing these requests, we look for similarities between the requested and existing telehealth services for the roles of, and interactions among, the beneficiary, the physician (or other practitioner) at the distant site and, if necessary, the telepresenter. We also look for similarities in the telecommunications system used to deliver the proposed service, for example, the use of interactive audio and video equipment.

  • Category 2: Services that are not similar to the current list of telehealth services. Our review of these requests will include an assessment of whether the service is accurately described by the corresponding code when delivered via telehealth and whether the use of a telecommunications system to deliver the service produces demonstrated clinical benefit to the patient. Requestors should submit evidence indicating that the use of a telecommunications system in delivering the candidate telehealth service produces clinical benefit to the patient. The evidence submitted should include both a description of relevant clinical studies that demonstrate the service furnished by telehealth to a Medicare beneficiary improves the diagnosis or treatment of an illness or injury or improves the functioning of a malformed body part, including dates and findings and a list and copies of published peer reviewed articles relevant to the service when furnished via telehealth. Our evidentiary standard of clinical benefit will not include minor or incidental benefits.

Some examples of clinical benefit include the following:
  •  Ability to diagnose a medical condition in a patient population without access to clinically appropriate in person diagnostic services.
  • Treatment option for a patient population without access to clinically appropriate in person treatment options.
  • Reduced rate of complications.
  • Decreased rate of subsequent diagnostic or therapeutic interventions (for example, due to reduced rate of recurrence of the disease process).
  • Decreased number of future hospitalizations or physician visits.
  • More rapid beneficial resolution of the disease process treatment.
  • Decreased pain, bleeding, or other quantifiable symptom.
  • Reduced recovery time.

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Services.html

As always Clinical Documentation for Medical Necessity is ALWAYS a consideration.  Be sure to document site specific, and avoid unspecified like the plague!  Don't be afraid of new policies and procedures.

Lois McGruder-Jarman, CPC is the Director of Coding & Compliance at MedCycle Solutions, which provides Revenue Cycle Management, Credentialing, Outsourced Coding, and Consulting Services to a number of healthcare providers in a variety of specialties. To find out more about MedCycle services or to sign-up for our free blog, please visit http://medcyclesolutions.com 

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