Questions: Telemedicine 3/31/20

Question 1: I will like to know if a nurse can do a telemed/telehealth and if so, what are the appropriate cpt codes?

A nurse can only bill for G2061-G2063 telecommunication interactions.  Phone only interactions are not allowed by Medicare because “incident to” services are not allowed for phone interactions at this point.  The interactions that are billable are those that can be transacted via secure exchange (portal or secure email) and the time spent by the nurse is added for the 7 day period.  Finally and perhaps initially the interaction should be patient-initiated by your established patients.  

Question 2: Can our doctors do telemed/telehealth for inpatient hospital follow-ups and codes?

Telemedicine in the inpatient setting appears to be allowed under COVID Below is from the fact sheet.  

  • Starting March 6, 2020, and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings.

Therefore inpatient visits should be reported with POS 02 as well and will be paid the Facility rate as these rates would apply as if you were in-person.  
Codes G0426-G4027 look to be more appropriate for Initial consults for inpatients and Codes G0406-G0407 look to be more appropriate for subsequent follow-up visits
The standard 99221-99223 and 99231-99233 may pay with the 02 to Medicare and may be required with other payers. 
As you report these services we are very interested in providing this information to others.  Please let us know if the services clear the clearinghouse and if the payer processes the claims.

Question 3: What is the code for Medicare telephone calls? G2012?

Code G2012 is for telephone only virtual visits with established patients that contact your office for follow up of simple to address problems.  Any problem requiring more attention and time from the Physician should be moved to a scheduled office visit using Video and Audio and charged with E/M codes as discussed.

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Mark N. Painter is a managing Partner of PRS Consulting, LLC, the CEO of PRS, LLC and the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS). Since co-founding PRS in 1989, Mr. Painter has served as the primary coding resource for the PRS products including Hotlines, Coding Manuals and quick reference tools, the Internet based application and seminars. He has lectured to a variety of groups concerned with health care reimbursement. Mr. Painter's extensive knowledge of physician reimbursement issues has allowed him to assist insurance companies, physicians and their staff members, legal counsel, actuaries, Specialty Societies and consultants on a daily basis. He has serves has an expert to legal counsel, bio device companies and pharmaceuticals. He was a co-chair of the Colorado Clean Claims Task Force, a committee of nationally known industry experts charged with the development of single payment edit database for the state. Mr. Painter is a CPMA. Mr. Painter received his B.A. from Grinnell College at Grinnell, Iowa.