Coding & billing for telehealth in GI: 8 things to know

Remote communication is enabling gastroenterology groups to continue practicing during the COVID-19 pandemic, according to Gastroenterology & Endoscopy News.

Glenn Littenberg, MD, a coding adviser for the American Society for Gastrointestinal Endoscopy and chair of the society's reimbursement committee, told Gastroenterology & Endoscopy News eight things to know about billing for telehealth visits in gastroenterology:

1. To bill Medicare for a telehealth visit scheduled in lieu of an office visit, use office visit codes 99201-99205, 99212-99215, office place of service 11, and modifier 95. Audio and video are required under the definition of telehealth.

2. Under CMS' March 31 interim rule, HIPAA requirements are suspended in case providers are unable to use secure encrypted methods during elective procedure shutdowns.

3. CMS drastically expanded coverage for telehealth services, retroactive to March 1. Emergency department services, inpatient admission and follow-up care, and most evaluation and management services performed by qualified providers are covered.

4. CMS will pay for telephone services provided to Medicare beneficiaries at the same rate as office visit codes 99212, 99213 and 99214. Telephone services can be billed under CPT codes 99441-99443, as well as under CPT codes 98966-98968 for qualified nonphysician providers.

5. Medicare reimbursement for telephone services can range from $14 to $41, depending on geographic location.

6. Patients who haven't received face-to-face E/M services for three years are considered new patients. Telehealth services for these patients should be closely tracked, as they are reimbursed at higher rates than telehealth services for patients seen more recently.

7. Virtual visits where the patient contacts the provider via telephone, email or online portal for a five- to 10-minute interaction are eligible for reimbursement. CMS will also reimburse e-visits that last a similar amount of time and include services such as diagnostic test setup and lab test procurement.

8. Private payers' policies on reimbursement for telephone services "vary widely" and aren't necessarily aligned with Medicare, Dr. Littenberg said.

Click here for more key insights.

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