Check new AMA scenarios for telehealth, COVID-19 coding guidance

by: Laura Evans, CPC Mar 26, 2020

Practices interested in how to code telehealth visits and encounters involving COVID-19 -- in light of recent waivers and policy changes -- can review 11 new coding scenarios released March 25 by the AMA.

The scenarios describe coding for a variety of remote visit situations, such as a patient being evaluated for possible COVID-19 testing, a follow-up visit for a confirmed COVID-19 patient and evaluation of a non-COVID-19 patient for a problem unrelated to the virus.

Interest in billing for remote patient visits has been high since CMS, the HHS OIG and the Office of Civil Rights waived many restrictions to protect clinicians and their patients from the COVID-19 virus. Effective March 6, CMS allows clinicians to connect with Medicare patients in their homes or in other locations via face-to-face video technology. Previous rules limited providers and patients to specific “originating” and “distant” sites.

Some examples from the AMA scenarios:

Patient is evaluated to see if COVID-19 testing is needed.

CPT coding: If a new patient, report 99201-99215, as appropriate. For established, select from 99212-99215 or, if by phone, 99441-99443. Note: phone codes are selected based on time).
Modifier: 95 (Telehealth service) if required by payer.
Place of Service: 02 (Telehealth).
Diagnosis coding: Z03.818 (Encounter for observation for suspected exposure to other biological agents, ruled out) or Z20.828 (Contact with and [suspected] exposure to other viral communicable diseases).

Patient receives virtual check-in/online visit for COVID-19.

CPT coding: Not applicable for new patients. For established patient, consider codes 99421 (5-10 minutes), 99422 (11-20 minutes) or 99423 (21-30 minutes).
HCPCS coding: G2010 (Remote image), G2012 (Virtual check-in).
Place of service: 11 (Physician office).
Diagnosis coding: Z03.818 (Encounter for observation for suspected exposure to other biological agents, ruled out) or Z20.828 (Contact with and [suspected] exposure to other viral communicable diseases).

Telehealth visit for a COVID-19 diagnosed patient, communication method is audio or audio/video.

CPT coding: If a new patient, report 99201-99215, as appropriate. For established, select from 99212-99215.
Modifier: 95 (Telehealth service) if required by payer.
Place of Service: 02 (Telehealth)
Diagnosis coding: U07.1 (COVID-19) if after April 1. Prior to April 1, code B97.29 (Other coronavirus as the cause of diseases classified elsewhere). Report also any manifestations of the disease, such as pneumonia.

Blog Tags: AMA, Breaking news, COVID-19, E/M services, telehealth

To comment, login here.

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.