Coding for Virtual Visits: How to Benefit from Current Reimbursement Opportunities

The health and safety of patients with COVID-19—as well as the providers treating them—have rightfully earned much of our focus recently. At the same time, however, social distancing measures meant to protect patients and providers alike are challenging the way all patients receive ongoing care.

The pandemic highlights how important it is, in certain cases, to allow hospitals and health systems to treat patients without being in the same physical location—such as through virtual visits. Recognizing this fact, the Centers for Medicare & Medicaid Services (CMS) and other payers have increased access to virtual visits. As of March 6, CMS temporarily is paying for virtual services to any healthcare facility for patients in any area of the country, including their homes. Specific evaluation and management (E/M) visits, mental health counseling services and preventive health screenings qualify under the new rules.

With proper documentation, coding, and billing, hospitals and health systems can benefit from Medicare reimbursement for three main types of virtual services during the COVID-19 public health emergency:

• Telehealth visits. Codes include G0425–G0427 (telehealth consultations, emergency department or initial inpatient); G0406–G0408 (follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs); and 99201-99215 (office or other outpatient visits). These services must be conducted using interactive audio/video telecommunications—no phone calls. They are considered the same as in-person visits and paid at the same rate during the COVID-19 emergency.
• Virtual check-ins. These services require an established patient to initiate communication from their home with their provider. It can be over the phone or through video or image. Codes G2012 and G2010 apply, but be careful. Note the time component for G2012, defined as a brief communication technology-based service not originating from a related E/M service within the previous 7 days nor leading to an E/M service within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
• E-visits. These services require established patients to use an online patient portal to initiate communication with their provider. Codes include 99421-99423 and G2061-G2063—for which time components are critical. For example, 99421 reflects an online digital E/M service for 5–10 minutes of cumulative time during a 7-day timeframe. Code 99422 is for 11-20 minutes cumulative time, and 99423 reflects 21 or more minutes. The same time pattern is in the descriptors for G2061-G2063 for online assessment and management by qualified non-physicians.

For hospitals and health systems that aren’t used to coding for virtual visits, ensuring code integrity can be tricky due to time components, as well as additional requirements for appropriate modifiers and place of service (POS) codes. However, some E/M coding solutions such as abeo’s TRUSTEDi10 can ease the burden, especially if your EHR does not automatically capture a time component that is needed for the virtual visit documentation for E/M coding. TRUSTEDi10’s EHR integration and artificial intelligence capabilities enable it to automatically capture compliant “time spent” language in the documentation and present the proper code for provider acceptance. In essence, it “reads” charts like a human but generates E/M code recommendations faster, more compliantly and more consistently—thus helping healthcare organizations derive more benefit from the current reimbursement opportunities.

We know that navigating unfamiliar virtual visit codes can be challenging. We’re here to support you. Learn more about TRUSTEDi10.