Telehealth Coding for Practices

 
The demands for telehealth have grown dramatically since the onset of the COVID-19 pandemic. With the Centers for Medicare & Medicaid Services (CMS) relaxing the rules for the use of non-HIPAA (Health Insurance Portability and Accountability Act) compliant technology and changing reimbursement regulations, telehealth has become one of the most effective and efficient means of care. Some private payers are also reimbursing for these visits. Yet, there continues to be confusion around the breakdown of codes.

For medical practitioner telephone visits, practices should use the 9944 coding (99441, 99442, 99443). Patients are required to initiate the services by simply calling the office and asking to see or speak to a provider. At that time, practice staff can help to educate the patient around a potential telehealth appointment, including discussing potential out-of-pocket costs. This specific service is based just on time on the call, as long as the patient has not had a visit within seven days for the same issue.

For medical practitioner online visits, practices will use 9942 coding (99421, 99422, 99423). These are communications through a HIPAA-compliant platform like an electronic health record portal or secure email. It is the secure portal that distinguishes this telehealth visit from the telephone call. Again, patients must initiate the service and the practice cannot report within seven days of a visit for the same issue. At the end of the seven days, the time is cumulative and reported with that specific code.

If your practice provides a face-to-face visit via Skype, FaceTime or other telehealth technology platform, you will select the appropriate E/M code and append the 95 modifier.
 
Practices that have not started offering telehealth and may need help getting started or have questions about the use of the codes, reach out to Kristy McGowan or John Dodd at practiceconsulting@amerisourcebergen.com.
 

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