Telemedicine CPT code compliance

A look at some of the unique telemedicine CPT code usage and documentation requirements that come with telemedicine or telehealth

FOR MANY CHIROPRACTIC PHYSICIANS WITH AN EXPANDED SCOPE OF PRACTICE, telemedicine opens the door to new ways of treating patients. Although telemedicine was originally intended for isolated communities and homebound patients, the convenience of on-demand health care in the comfort of home is quite appealing for many busy individuals.

Functional medicine, patient follow-ups, and some primary care services can work very well in this format.

Unique telemedicine CPT code requirements

Telemedicine is a specific type of telehealth service. It requires interactive video and audio communication between the health care provider and patient that can occur live or be recorded to be evaluated at a later time. The encounter must be perma-nently stored via either electronic or hard copy, and thus the patient must be made aware that they are being recorded and give their consent.

Telemedicine encounters must also document information that is unique to virtual visits. All members of the health care team who are present during the service should be listed, as well as any individuals the patient may have with them. The note should also specify what state the patient is in while they are receiving care and whether they are at home, work, a health care facility such as a hospital, or in long-term care, a hotel, etc.

Coding telemedicine correctly

When performed by a doctor, telemedicine CPT codes 99421-99423 are to be used. These are only to be used for established patients who have not had an in-office E/M service billed by the same provider within the same seven-day period. Telemedicine CPT codes are time-based and reflect the cumulative time spent in a tele-medicine service over a seven-day period. These codes should be billed as follows:

• 99421: Online digital E/M service for an established patient for up to seven days. Cumulative time: 5-10 minutes.
• 99422: Online digital E/M service for an established patient for up to seven days. Cumulative time: 11-20 minutes.
• 99423: Online digital E/M service for an established patient for up to seven days. Cumulative time: 21 or more minutes.

Since the service is performed electronically versus a traditional office visit, a different place of service (POS) code must be reported in Box 24b on the 1500 claim form. Code “02” indicates that the E/M service was performed via telehealth. Additionally, if the telemedicine visit is synchronous — meaning that the interaction is a live, two-way audiovisual communication — the “-95” modifier should be attached to the telemedicine E/M service code being billed.

Coverage considerations

When it comes to billing third-party payers for this service, we apply the “Golden Rule”: He who has the gold makes the rules. That means that the payer will decide the following:

• Is telemedicine a covered service?
• If it is a covered service, which provider types are eligible for reimbursements?
• Is there a limitation as to how many telemedicine visits are approved?
• What are the medical necessity elements necessary for reimbursement?

Check with each payer’s medical review policy to determine whether policy exists regarding these components.

Compliance considerations

All electronic communications and record storage that contain protected health information are subject to HIPAA regulations to ensure patient privacy, among other requirements.

Telemedicine can be an adjunct service to an already-established practice or used as an entirely new way to treat patients. The possibilities continue to expand as technology advances, and creating policies and procedures ensures that the standard of care will be met.

Karen Sedore, DC, CPCO, has more than 13 years of experience working in the chiropractic profession. She joined KMC University in 2017 and assists doctors and their staff in her current role as a membership advisor.