First rule is medical necessity. Second consistency.
If the patient needs care, provide the care in the method that meets the needs of the patient and protect the health and safety of the patient and others.
As far as rules go relative to frequency, none have been published yet. The situation is fluid and what we are seeing is a series of tweaks to rules as new issues come up. If Medicare starts to see what they perceive as abuse they are going to react. If everyone seems to be behaving they have bigger fish to fry and will leave it to physicians to self-police. We do have a few suggestions that you can incorporate. I will try and layout a few examples and provide suggestions below
- Assume generally, you are going to want to maintain the patient relationship, as close to what is typical without Telemedicine, as possible. This may be a bit more difficult as patients start to think they have access to the physician and APP via phone/telemedicine 24/7. Attempting to help patients understand that the telemedicine visits are a substitute for an office visit, when it can be, will assist in controlling both patient expectations and continuity of care.
- How to bill Telemedicine visits that result in a request to have the patient come into the office:
- If the Telemedicine encounter proves to be too difficult or does not provide the physician with enough information to diagnose and treat and results in a recommendation for the patient to come into the office, at the next available appointment, then do not bill a Telemedicine visit.
- If the Telemedicine visit results in directing the patient to come into the office for a UA or other diagnostic service, to further diagnose the problem, or the visit results in the patient being directed to come into the office or other place of service, for treatment (catheterization, injection, x-ray, ultrasound, etc.) document the Telemedicine visit and charge encounter under the appropriate office visit code with POS 02. Schedule as appropriate for the condition.
- If the patient is seen in the office and a follow-up is conducted remotely:
- In-office visit includes a test and you are communicating results of the test provided remotely (i.e. UA negative or culture and sensitivity indicates correct drug) no charge for follow up call. It can also be communicated via web portal, again no charge.
- In-office visit conducted and remote follow-up with test results include treatment discussions. (biopsy positive with a discussion of next steps). Document and charge remote office visit with a place of service 02. Use Telemedicine technology to conduct the visit (audio and visual).
- In-office visit conducted and patient calls-in to ask about treatment or to report dissatisfaction or complication with treatment. Consider G2012 and phone call only, if the visit is relatively low intensity and the Physician or APP can simply change meds due to patient compliance or lack of resolution. The timing of this type of visit should be longer than one week after the visit. The Physician or APP can encourage the patient to call the office if there is a problem with the Rx. Phone call must be conducted by the Physician or the APP.
- Patent is seen and provided an Rx. The patient is encouraged to use the patient portal to message with any questions or issues. For example, let’s say 10 days later the patient messages that meds are causing intolerable side effects. The physician or APP messages the patient asking for symptoms and asks if the problem is being addressed. The patient returns a message states that symptoms are better but side effects cannot be tolerated. Physician or APP messages to try for one more day to see if side effects subside. Patient emails back that side effects are not better. Physician or APP calls in a new RX and notifies patient. The email exchange was done over a two day period with a total physician or APP time of 12 minutes. Document the time spent and charge 99422.
- Office visit conducted and patient is provided treatment and a new visit is scheduled for a future date. The patient then calls a few days later regarding this or a new problem. If a new problem is reported, that cannot be handled by the Nurse or staff, schedule a telemedicine visit as medically appropriate, document and charge Telemedicine visit, when provided.
I hope this helps and please let us know if you any additional questions in the PRSNetwork.com Urology Coding and Reimbursement Group, click to sign up for free now.