Coding

Can you please help me ensure that we are coding this scenario correctly. 
Pt SY is seen by APP via telehealth (video) for consultation due to maternal history of Crohn's disease. 25 minutes is spent in face-to-face video counseling with the patient. An additional 40 minutes is spent in pre- and post-visit activities - reviewing available literature, prepping the counseling.
My understanding is that this would be billed as a 60-minute consultation, with the use of the virtual modifier for telehealth service. 
Appreciate your input.

------------------------------
Angelica Glover
------------------------------

Original Message:
Sent: 6/4/2020 10:53:00 AM
From: Angelica Glover
Subject: Telehealth consult question

Can you please help me ensure that we are coding this scenario correctly. 
Pt SY is seen by APP via telehealth (video) for consultation due to maternal history of Crohn's disease. 25 minutes is spent in face-to-face video counseling with the patient. An additional 40 minutes is spent in pre- and post-visit activities - reviewing available literature, prepping the counseling.
My understanding is that this would be billed as a 60-minute consultation, with the use of the virtual modifier for telehealth service. 
Appreciate your input.

------------------------------
Angelica Glover
------------------------------

------------------------------
Steve Rad
------------------------------

Original Message:
Sent: 06-05-2020 00:25
From: David Jones
Subject: Telehealth consult question

It is not clear to me that you can include non-face to face time in your time codes for E&M as a straight part of the consult, although CMS has apparently relaxed rules that might allow you to code time based on " ll of the time spent on the E&M" but in a conservative world, our hospital has wanted us to stick to face-to-face time. Also, looking at some CMS guidelines that broaden the scope of telemedicine, I see that the " ew patient" codes are included but haven't seen the "consult" E&M's included-although perhaps that is because they don't recognize them any more. Nonetheless, at my institution, if you spent 25 min in face to face time, that is either a 99241 (if billed as consult) or 99202 (new outpatient)-our institution won't let us use the time code as an average, if we are 1 minute shy of the "average" time using time codes, we must round down. 

However, there might be a "separate add-on" code that you can bill along with the regular E&M. In cases where I had to do a lot of research or prep work for a patient's consult or plan, I have been told I can will 99358 for 31–75 minutes of extra non-face to face time and there is a 99359 that adds more time to that.

"Codes 99358 and 99359 are used when a prolonged service is provided that is neither face-to-face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an evaluation and management service and is beyond the usual physician or other qualified health care professional service time." A provider is allowed to bill for non-face-to-face prolonged service on a different date than the primary service. This prolonged service can take place either before or after the actual face-to-face care, as long as the non-face-to-face time spent relates to the past or future direct, face-to-face care of the patient and to ongoing patient management. These codes can only be billed when this extra time spent is "beyond the usual" time a provider would spend.

So if you spent 25 min in face-to-face, you might bill 99214 (or 99202) with a GT modifier, and then you would also bill 99358 for the other 40 minutes of non-face to face time.

This all seems much more complicated than it needs to be!

Best regards,

David C Jones, MD

Director, University of Vermont Medical Center Fetal Diagnostic Center

Professor, Obstetrics, Gynecology & Reproductive Sciences

University of Vermont

Dept of Obstetrics, Gynecology & Reproductive Sciences

Division of Maternal-Fetal Medicine

(802) 847-5698

david.jones@UVMHealth.org

Original Message:
Sent: 6/4/2020 10:53:00 AM
From: Angelica Glover
Subject: Telehealth consult question

Can you please help me ensure that we are coding this scenario correctly.
Pt SY is seen by APP via telehealth (video) for consultation due to maternal history of Crohn's disease. 25 minutes is spent in face-to-face video counseling with the patient. An additional 40 minutes is spent in pre- and post-visit activities - reviewing available literature, prepping the counseling.
My understanding is that this would be billed as a 60-minute consultation, with the use of the virtual modifier for telehealth service.
Appreciate your input.

------------------------------
Angelica Glover
------------------------------

Thank you both - your answers were very helpful. 

Angelica Glover MD
Maternal-Fetal Medicine
University of North Carolina at Chapel HIll

------------------------------
Angelica Glover
------------------------------

Original Message:
Sent: 06-05-2020 02:50
From: Steve Rad
Subject: Telehealth consult question

Hi Angelica,

Agree with David. E/M codes are based on total face to face time with the patient. For non face to face time, use the prolonged services codes. 

**In the interim during the pandemic emergency, CMS guidelines have temporarily removed some restrictions and allow inclusion of non face to face time however you would have to check with your individual private payers if they followed suit with allowing this at this time in which case you might be able to code as you noted. Exciting news is that there will be key changes to E/M coding in 2021 coming that will include "total time spent on the day of the encounter" instead of just face to face time among other nice changes in requirements, but have to wait for 2021 for that 🙂.

You can find the SMFM Coding Committee guidance on telemedicine here https://s3.amazonaws.com/cdn.smfm.org/media/2301/COVID19_Updated_Telemedicine_White_Paper_April2020.pdf

Also may visit SMFM Coding site for other helpful resources https://www.smfm.org/coding


Hope this helps. Thank you. 

____________________________________

Steve Rad, MD, FACOG

OBGYN/Maternal-Fetal Medicine

Director, Los Angeles Fetal & Maternal Care Center

Cedars-Sinai Medical Office Towers

8631 W. 3rd St., East Tower #205

Los Angeles, CA  90048

Office: 310-299-7561

Fax: 310-299-7695

------------------------------
Steve Rad

Original Message:
Sent: 06-05-2020 00:25
From: David Jones
Subject: Telehealth consult question

It is not clear to me that you can include non-face to face time in your time codes for E&M as a straight part of the consult, although CMS has apparently relaxed rules that might allow you to code time based on " ll of the time spent on the E&M" but in a conservative world, our hospital has wanted us to stick to face-to-face time. Also, looking at some CMS guidelines that broaden the scope of telemedicine, I see that the " ew patient" codes are included but haven't seen the "consult" E&M's included-although perhaps that is because they don't recognize them any more. Nonetheless, at my institution, if you spent 25 min in face to face time, that is either a 99241 (if billed as consult) or 99202 (new outpatient)-our institution won't let us use the time code as an average, if we are 1 minute shy of the "average" time using time codes, we must round down. 

However, there might be a "separate add-on" code that you can bill along with the regular E&M. In cases where I had to do a lot of research or prep work for a patient's consult or plan, I have been told I can will 99358 for 31–75 minutes of extra non-face to face time and there is a 99359 that adds more time to that.

"Codes 99358 and 99359 are used when a prolonged service is provided that is neither face-to-face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an evaluation and management service and is beyond the usual physician or other qualified health care professional service time." A provider is allowed to bill for non-face-to-face prolonged service on a different date than the primary service. This prolonged service can take place either before or after the actual face-to-face care, as long as the non-face-to-face time spent relates to the past or future direct, face-to-face care of the patient and to ongoing patient management. These codes can only be billed when this extra time spent is "beyond the usual" time a provider would spend.

So if you spent 25 min in face-to-face, you might bill 99214 (or 99202) with a GT modifier, and then you would also bill 99358 for the other 40 minutes of non-face to face time.

This all seems much more complicated than it needs to be!

Best regards,

David C Jones, MD

Director, University of Vermont Medical Center Fetal Diagnostic Center

Professor, Obstetrics, Gynecology & Reproductive Sciences

University of Vermont

Dept of Obstetrics, Gynecology & Reproductive Sciences

Division of Maternal-Fetal Medicine

(802) 847-5698

david.jones@UVMHealth.org

Original Message:
Sent: 6/4/2020 10:53:00 AM
From: Angelica Glover
Subject: Telehealth consult question

Can you please help me ensure that we are coding this scenario correctly.
Pt SY is seen by APP via telehealth (video) for consultation due to maternal history of Crohn's disease. 25 minutes is spent in face-to-face video counseling with the patient. An additional 40 minutes is spent in pre- and post-visit activities - reviewing available literature, prepping the counseling.
My understanding is that this would be billed as a 60-minute consultation, with the use of the virtual modifier for telehealth service.
Appreciate your input.

------------------------------
Angelica Glover
------------------------------