COVID-19 + Telehealth: Need-to-Know Info for Medical Practices

In the past few days, we’ve fielded countless client questions about telehealth changes in the midst of the coronavirus outbreak. So we want to provide you with a succinct overview of what you most need to know—along with a list of resources you can explore for more detailed information.

A doctor in a face mask works in a lab to represent the need for the telehealth waiver during the coronavirus COVID-19 outbreakFirst off, 2 important notes about this blog post:

  1. This is a dynamic blog post that we will be expanding and updating in the days and weeks to come, as more information becomes available. When we make significant updates, we will also notify our subscribers, so sign up or check back often. And if you have questions, ask. We’ll likely add answers right here.
  2. We’re not looking to profit in any way from sharing this information. But since we do believe it can help practices stay informed and healthy, we are allowing any type of sharing of this information. Send out the link, screenshot the post, attach this free PDF to an e-mail, or just copy and paste the content of the post into any communication medium you prefer. We don’t care about credit or attribution. We just want practices to find the information and support they need.

Now to the meat:

Telehealth Updates Related to COVID-19

Amid COVID-19 concerns, many insurance providers have temporarily implemented drastic updates to patients’ telehealth coverage. For the good of patients and the health of business, it’s essential that medical providers understand these unique, short-term changes. Most basically:

  • As of March 6th, 2020, many insurances have expanded telehealth coverage for their patients in light of the COVID-19 outbreak
  • In addition to expanding services via telehealth, many carriers are also waiving copays and/or coinsurances for certain services
  • HIPAA has loosened some rules to allow providers to use Skype, FaceTime, and other otherwise disallowed communication tools for corresponding with patients.

Additional Services with Waived Telehealth Requirements during the Coronavirus Outbreak

Medicare and most commercial carriers are waiving the normal requirements for many other services in order to allow for telehealth billing. 

Both mental health and medical nutrition are included on this list. But there are many more. Click here to see the full & expanded list. 

In addition, Medicare is providing a waiver to the typical requirements dictating a patient’s location at the time of services.

Approved Telehealth Technology during the Coronavirus Outbreak

Typically, telehealth services must be provided through approved technology. But according to the Department of Health and Human Services (HHS), during the time of this COVID-19 waiver, “covered healthcare providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance.”

While we at AHS still recommend one of the traditionally approved video services (more on that below), we want you have to have easy access to the free options as well. So for information on how to get started with some of those services, checkout these links:

Updox: Our Recommended Telehealth Solution

While it’s wonderful that HHS has opened their restrictions on free telehealth services during this unique time, at the moment, we still believe Updox is a great choice (no affiliate links here…we don’t make anything on this; just sharing our opinion in case it’s helpful).

Here are a few of the reasons we think this is a good choice:

  • The provider-patient user connection is simple and easy to use on iOS devices like iPhone and iPad, Android devices, and laptops, allowing for much flexibility.
  • Updox is HIPAA compliant, so when this crisis is over and the standard regulations are put back in place, you will be able to continue using the same software for you telehealth program going forward.
  • Their video-chat-only package is $49.99 per medical provider per month, with no annual contract. You can choose from a variety of add-on products during your initial setup or at a later day.
Check out the 2-minute video chat demo on their registration page for more info.

Coding Telehealth Video Visits & Exams

Obviously, physical limitations mean that video visits and exams are inherently different than in-person visits. But as a provider, your overall chart note should contain the same information.

To record video visits and exams in your chart, we recommend you treat them almost exactly as you would any evaluation and management visit for an established patient, with a few small tweaks. Here’s the breakdown:

  • Use codes 99213 – 99215, evaluation and management for established patients
  • Begin your chart note with the following: “Using [name of video conferencing software, e.g. Skype], a video conferencing software, [patient name], on [date]…”
  • Progress through your evaluation and management notes
  • End by recording the time of the video call

In other words, to document the video call, treat it almost exactly as you would if the patient were sitting in front of you.

A few important notes on how to code these visits, since many of you have specifically asked about this:

  • For Medicare patients, codes 99213 – 99215 must be billed with the GT modifier.
  • For commercial patients, these codes must be billed with the 95 modifier
  • For Place of Service (POS), add “02” to indicate telehealth as the facility.

Duration of the Telehealth Waiver

At this moment, it is not known how long this waiver will be in effect. There are a few Medicare Advantage plans that have set an end date of April 30th, but they may have to push these dates out further.  

Regardless, we will update this blog post and send an email to our subscribers when the date is known. 

Private Health Insurance COVID-19 Telehealth Codes

BCBS, along with a majority of commercial insurances, currently recognize a specific set of phone telehealth codes as payable. (These are not payable by Medicare.)

CODEDESCRIPTION
99441Physician / qualified health professional telephone evaluation, 5 - 10 minutes
99442Physician / qualified health professional telephone evaluation, 11 - 20 minutes
99443Physician / qualified health professional telephone evaluation, 21 - 30 minutes

Medicare COVID-19 Telehealth Codes

Medicare has their own set of telehealth codes for the following services:

CODEDESCRIPTION
G2010Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours
G2012 Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 5 - 10 minutes of medical discussion

The codes above can not be related to a previous evaluation and management service within the last 7 days and cannot lead to an appointment within the next 24 hours.

Codes for Digital Communication through Online Patient Portals

Medicare and commercial carriers are also paying for digital communication through online patient portals.  

Medicare is only paying these codes for physicians, but there is a comparable code for qualified non-physician providers (see below). 

These codes are based on a cumulative time that covers at least 7 days or more of treatment.

CODEDESCRIPTION
99421Physician / qualified health professional online digital evaluation, 5 - 10 minutes
99422Physician / qualified health professional online digital evaluation, 11 - 20 minutes
99423Physician / qualified health professional online digital evaluation, 21 - 30 minutes

…and Medicare’s comparable codes for non-physican providers:

CODEDESCRIPTION
G2061
Qualified nonphysician health care professional online assessment, for an established patient, for up to 7 days, cumulative time during the 7 days; 5 - 10 minutes
G2062
Qualified nonphysician health care professional online assessment service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11 - 20 minutes
G2063
Qualified nonphysician qualified health care professional assessment service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

Any codes listed in the Medicare approved telehealth list that are not detailed in this post also need a modifier -GT for Medicare or Medicare Advantage plans, or modifier -95 for commercial plans when done via telehealth.  

Additional Information

For more detailed information, we recommend exploring these links:

https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf  

https://mhealthintelligence.com/news/medicare-expands-telehealth-coverage-to-curb-coronavirus 

https://bphc.hrsa.gov/emergency-response/coronavirus-frequently-asked-questions.html 

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200316c.aspx 

https://www.medicare.gov/medicare-coronavirus 

 https://www.bcbsil.com/provider/education/2020/2020_03_11.html  

https://www.uhcprovider.com/en/resource-library/news/provider-telehealth-policies.html 

https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

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