The reality of virtual check-in coding

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Q: Effective Jan. 1, 2019, there is a new Medicare code for virtual check-ins, G2012. It appears to be for when the patient calls to see if he needs an office visit. I want to use for those weekend calls while on-call, but our management says we shouldn’t. Can you please give me your interpretation of this code?

A: You have the basics correct. The Centers for Medicare & Medicaid Services (CMS) describes code G2012 as “a brief communication technology-based service when the patient checks in with the practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed.” Under certain circumstances, there is no reason you couldn’t use this code when patients call while you are on-call.  

But, there are several qualifying descriptors for this code as well as some circumstances

to consider. This new G2012 code, similar to the codes in the CPT manual for telephone and other electronic contacts, requires these communications:

• are limited to established patients,

• can't be related to an office visit in the previous seven days,

• can't result in being seen for a next available office appointment or within 24 hours, and

• must have 5 to 10 minutes of medical discussion.

After discussion, you might end up sending the patient to a specialist, a more acute setting, or even advising them to make (or keep) a future appointment with you to address the problem. If all the above conditions above are met, you can code for a virtual check-in.

Payers like virtual check-ins because the provider is prescreening a problem-triaging it if you will-to determine whether the patient needs an office visit soon or not. If the patient does, the call is bundled into that visit.

From the payer perspective, this virtual check-in does two things:

• It may save an office visit.

• It may direct the patient as needed to the appropriate caregiver in a medically necessary situation, perhaps leading to cost savings down the road.

This is also in line with CMS’s movement towards technology-based solutions.

One reason not to use this code might be as simple as the copay. Even though the Medicare copay on this would be around $2.50, you can imagine how patients might perceive this when they receive a bill: “You mean I can’t even call my doctor without you charging me $2.50 for a phone call!”

Patients are sensitive to billing. This code could actually be a huge patient dissatisfier even though you provided a valuable and timely service. Perception is everything, so be prepared if you decide to use the G2012. Train your staff on when to use it-and what they should say to upset patients.

 Q. Is it true that the diagnosis code E53.8, deficiency of other specified B group vitamins, is no longer sufficient to be reimbursed for a B12 shot?

A: Yes, this code no longer meets medical necessity on its own. Payers are now requiring additional diagnosis. Most plans exclude coverage of nutritional supplements without a defined medical condition. Payers will not pay for oral vitamins that that are prescribed or can be purchased without a prescription.

Bill Dacey, MHA/MBA, CPC is principal in The Dacey Group, Inc., a consulting firm dedicated to coding, billing, documentation, and compliance concerns for physicians. Dacey is a AAPC-certified coding instructor and has been active in physician training for more than 25 years. He can be reached at billdacey@msn.com.