Coding during the Coronavirus pandemic

Q1:  With the Coronavirus Emergency, what are our coding options for ‘seeing’ patients remotely? It looks like Medicare has opened up the Telehealth or Telemedicine options?

A1:  There are numerous options when it comes to reporting visits that are not the traditional face-to-face office visit. This varies somewhat by payer, of course.

As you mention, on 3-17-20 Medicare has temporarily relaxed some of the geographic and security/privacy restrictions on Telehealth visits – including the office visit codes. This will allow patients to call your office, and as long as there is some type of combined audio/video communication between the provider and the patient – these ‘visits’ can be billed with the 99201-99215 series codes, adding the 95 modifier.

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Medicare options: 

1. Office Codes 99201-99215 – The new visit codes to the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency

Any new visit codes 99201-99205 would likely need to be coded based on time given the limitations of the exam. The established patient codes 99211-99215 could be billed by counseling time or by documenting the level of history and medical decision-making associated with a given code level. 

2. Virtual Check-Ins (e.g. telephone calls) The G2012 - A brief (5-10 minutes) check in with your practitioner via telephone or other telecommunications devise to decide whether an office visit or other service is needed. This is provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment

3. The E-Visits - Online digital E&M service, for an established patient, for up to 7 days, cumulative time during the 7 days. For Medicare these are

• -G2061 – for up to 7 days, cumulative time during the 7 days; 5-10 mins.

• -G2062 – for up to 7 days, cumulative time during the 7 days; 11-20 mins.

• -G2063 – for up to seven days, cumulative time during the 7 days; 21 or more minutes.  

For commercial/payers and some Medicare Replacement plans:

• -99421- 5-10 mins

• -99422 - 11-20 mins.

• -99423 – 21 or more minutes.

Those are the mainstream codes to consider here. Reimbursement varies with the office visit codes typically paying the most.

Although we cannot speak broadly for all payers, many have allowed, at least temporarily, the use of the office visit codes for Telehealth during the COVID-19 Emergency.

Some states, starting with Massachusetts, have mandated that commercial payers cover Telehealth during the crisis.

Go the websites for United Healthcare, BCBS, Aetna, CIGNA, Humana and others for specific policy changes. 

To document your visit, be sure to note in your EMR the date, time and duration of the encounter. Also record the relevant history, and exam, decision-making and other management elements as you would any other visit.

 Read More: Coding for telemedicine visits

For Diagnosis coding consider the following:

Code B34.2 (coronavirus infection) in addition to manifestation

Code B97.29 for COVID 19 Diagnosis

Possible Exposure to COVID-19 ruled out

Z03.818

Exposure to person with confirmed COVID-19

Z20.828

Pneumonia 

J12.89

Acute bronchitis 

J20.8

Respiratory infection NOS 

J98.8 

Acute respiratory distress syndrome (ARDS)

J80 

Bill Dacey, MHA, MBA, CPC-I is principal in The Dacey Group, Inc., a consulting firm dedicated to coding, documentation and compliance concerns for physicians. Bill is an evaluation and management (E/M) coding expert and has been active in physician training for more than 25 years. He can be reached at billdacey@msn.com.