Codes for Telemedicine Pain Management Doctors

Telemedicine Pain Management Doctors

Telemedicine pain management doctors play a vital role in the healthcare of individuals living at a distance. Telemedicine refers to remotely providing healthcare services like evaluation, diagnosis, and treatment of a particular disorder. This requires physicians to utilize information technology and communication tools. According to AMA, telehealth and telemedicine payment and policy are still complex. Proper medical billing for telemedicine for chronic pain or other telehealth services is crucial for timely reimbursement. This is why healthcare providers must be familiar with coding methodologies and telemedicine billing guidelines.

Common Codes Used by Telemedicine Pain Management Doctors

Telemedicine CPT codes:

Following are the common telemedicine codes for billing:

– 99202-99205: Office/outpatient E/M visit, new:

•         99202   Office/outpatient visit new (15 to 29 minutes of total time on the encounter on a single date.)
•         99203   Office/outpatient visit new (30 to 44 minutes of total time on the encounter on a single date.)
•         99204   Office/outpatient visit new (45 to 59 minutes of total time on the encounter on a single date.)
•         99205   Office/outpatient visit new (60 to 74 minutes of total time on the encounter on a single date.)

– 99211-99215: Office/outpatient E/M visit, established

• 99211    Office/outpatient visit established; (for an office or other outpatient visit for an established patient that may not require the presence of a physician or other qualified healthcare professional).
• 99212   Office/outpatient visit established; (for an office visit or other outpatient visit for an established patient, 10 to 19 minutes of total time on encounter on a single date. It involves the straightforward level of medical decision-making.)
• 99213   Office/outpatient visit established; (For an office visit or other outpatient visit for an established patient, 20 to 29 minutes of total time on encounter on a single date. It involves a low level of medical decision making.)
• 99214   Office/outpatient visit established; (For an office visit or other outpatient visit for an established patient, 30 to 39 minutes of total time on encounter on a single date. It involves a moderate level of medical decision making.)
• 99215   Office/outpatient visit established; (For an office visit or other outpatient visit for an established patient, 40 to 54 minutes of total time on encounter on a single date. It involves a high level of medical decision making.)

During the COVID-19 pandemic, there was an increase in telemedicine services. Telephone codes some new telephone codes were also added. Including:

– CPT 99441 to 99443 under non-face-to-face telephone services.

• CPT 99441: For evaluation and management (E/M) services performed by the provider over a telephone for about 5 to 10 minutes. This code lies under “non-face-to-face telephone services.”
• CPT 99442: For evaluation and management (E/M) services performed over the telephone by the provider for a conversation lasting up to 11 to 20 minutes.
• CPT 99443: For evaluation and management (E/M) services performed by the physician over the telephone for a conversation lasting up to 21 to 30 minutes.

Note: Telemedicine pain management doctors should remember these codes are a Temporary Addition to the COVID-19 pandemic. This temporary addition is for the PHE and was added on 30th April 2020, and the list of Medicare Telehealth services was last updated on 5th January 2022.

Telemedicine HCPCS codes:

Commonly used HCPCS codes for telemedicine include:

– G0425-G0427 Initial Telehealth Consultations (telehealth consultation, initial patient and emergency department).

•   G0425: Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth
•   G0426: Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
•   G0427: Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth

– G0406-G0408 Follow-up Telehealth Consultations (follow-up inpatient telehealth consultations for patients in SNFs or hospitals.)

•    G0406: Follow-up inpatient consultation, is limited; physicians typically spend 15 minutes communicating with the patient via telehealth
•    G0407: Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
•    G0408: Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth

Reimbursement and Telehealth:

Reimbursement for telehealth services is the tricky part. It primarily depends on the type of healthcare practice, insurance payers, your services, and the healthcare state. Following are some of the guidelines:

–         Determine your telehealth type:

The first step is to determine the type of telehealth services, for instance, whether you’re offering a live video solution or using software for remote patient monitoring. The reimbursement highly depends on this.

–         Understand the Medicare:

The common CPT and HCPCS codes are listed above. Note that only CPT codes and HCPCS codes are eligible for telemedicine or telehealth reimbursements. A complete list of Medicare telehealth services is also available on the official website of CMS.

Using the right modifier is also crucial for reimbursements.

–         Trained and experienced medical billing staff:

Having a team of trained professionals is important for medical billing. They are familiar with the coding systems, know how to prepare and submit a claim, and be up-to-date with all the changes in the guidelines and codes.

Therefore, using the right codes and right modifiers, submitting a clean claim in time results in:

–         Faster payments

–         An improved and higher reimbursement rate

–         Streamlined cashflows.

Telemedicine Billing Errors:

Due to COVID-19, there has been a massive increase in telehealth or telemedicine services. Healthcare providers like telemedicine pain management doctors worked on improving telehealth services keeping social distancing under consideration. Telemedicine makes medical billing even more complex. There are several errors associated with it, which is why physicians must be familiar with telemedicine billing 2022, billing codes for telemedicine, and their guidelines.

Outsourcing Medical Billing Services:

Medical billing is an essential payment practice in the healthcare system. It ensures that the healthcare providers are being reimbursed for the services and procedures they render. If not done correctly, it directly impacts healthcare revenues and cash flows. Outsourcing medical billing comes with a number of benefits, including lesser errors and costs, faster payments, and a higher reimbursement rate.

Some of the benefits of outsourcing medical billing include the following:

–         More focus on the patient care

–         Lesser errors

–         A team of highly professional medical billers

–         Proper denial management

–         Single point of contact

–         Lesser costs; (elimination of fixed costs like salaries, computer equipment, medical billing software maintenance, and purchase).

What is Telemedicine?

Telemedicine involves providing patients with remote clinical services using information and technology. This allows patients living far away to get care, advice, monitoring, and education via a healthcare professional. COVID-19 has increased telemedicine at a massive level. Due to social distancing, telemedicine played a vital role in bridging the gap between people and healthcare. Based on this increase, new codes were introduced. There are three common types of telemedicine:

–          Interactive Medicine:

Includes real-time communication between the patient and the physician, maintaining HIPAA compliance.

–          Store and Forward:

This allows the healthcare provider to share the patient’s information with a practitioner at another location.

–          Remote Patient Monitoring:

This involves using mobile devices to collect data, e.g., blood sugar. This is for the healthcare providers or caregivers to monitor the patient’s condition. It is for the patient’s staying at home.

CPT codes and HCPCS codes in Telemedicine

CPT Codes:

CPT stands for Current Procedural Terminology and is maintained by the American Medical Association (AMA). CPT codes are for healthcare providers; administrative tasks like claim processing for healthcare services are performed. These codes are used to report medical, surgical, and diagnostic procedures with a “uniform coding language.”

CPT Codes play a vital role in medical billing and coding. These codes are divided into the following categories:

–          Category I:

Like the ICD code set, category I code comprises six large sections or chapters. This code set is represented with five digits. They include:

•         Evaluation and Management Services
•         Anesthesia
•         Radiology Procedures
•         Pathology and Laboratory Procedures
•         Medicine Services and Procedures
•         Surgery

Most time of the coders is spent using Category I of the CPT coding system.

–          Category II:

Category II CPT codes are used for performance measurement. This code set comprises four digits and an alphabet (F) at the end of the code. For instance, Patient History (1000F–1505F).

Category I and III codes can never replace category II codes. These codes simply just provide extra information to these codes.

–          Category III:

Category III codes consist of experimental procedures that may get added to the Category I code set. This category code is made up of temporary codes for emerging technology, procedures, and experimental services.

The category I code set consists of procedure codes for unlisted services. But if the procedure or service is already listed in Category III code set, medical billers are required to use that code.

CPT Modifiers:

Using the right modifiers in the right way is essential for medical coding. Using the wrong modifiers can result in claim denials, late reimbursements, and therefore lost revenues.

Commonly used modifiers in medical billing include:

–         Modifier 59

–         Modifier 25

–         Modifier 26

–         Modifier 91

HCPCS Codes:

HCPCS stands for Healthcare Common Procedure Coding System, commonly referred to as HCPCS Level II Classification codes. This code set is specifically for healthcare providers, medical equipment suppliers, and physicians. It involves:

–         Medical devices

–         Supplies

–         Medications

–         Transportation services

–         And any other items or services

Structure of HCPCS codes:

These codes consist of five characters, starting with an alphabet from A to V, followed by four digits. For instance, the HCPCS code set G0425-G0427 is for Initial Telehealth Consultations (telehealth consultation, initial patient, and emergency department).

How are medical codes used?

As the American Academy of Professional Coders (AAPC) stated:

–         CPT codes are for what the physician or healthcare provider did.

–         HCPCS codes are for what the physician or healthcare provider used.

–         ICD-10-CM codes are for why the healthcare provider or physician did or used what they did.

  Frequently Asked Questions (FAQs):

What does telemedicine billing mean?

Telemedicine billing involves the billing of prescriptions by a physician from remote monitoring. Proper medical billing for telemedicine or telehealth services is crucial for timely reimbursement. This is why healthcare providers must be familiar with coding methodologies and telemedicine billing guidelines. COVID-19 has increased telemedicine at a massive level. Due to social distancing, telemedicine played a vital role in bridging the gap between people and healthcare.

What are common telemedicine billing errors?

Using incorrect billing codes is one of the most common billing errors in telemedicine billing. Some other common coding or billing errors include:

–         Incorrect time duration of the visit

–         Incomplete or inaccurate documentation

–         Patient consent (for a virtual consultation, make sure you ask for their verbal or written consent.

–         Make sure to choose the correct code category. For instance, the “telephone” codes are only for audio visits.

What is telemedicine in medical billing?

Telemedicine refers to remotely providing healthcare services like evaluation, diagnosis, and treatment of a particular disorder. The role of telemedicine pain management doctors had massively increased due to the COVID-19 pandemic. This is why Medicare introduced new codes for Telehealth services. Including CPT 99441 to 99443 under non-face-to-face telephone services.

References:

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

https://www.aapc.com/codes/cpt-codes-range/99211-99215/

https://www.aapc.com/codes/cpt-codes-range/99202-99205/

https://www.aapc.com/codes/hcpcs-codes-range/148/

https://www.aapc.com/codes/hcpcs-codes-range/154/

Touseef Riaz

A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.