Telehealth Billing Guidelines for Orthopedics

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Telehealth Billing Guidelines for Orthopedics
During the COVID-19 public health emergency,
reimbursements for telehealth continue to evolve.
The federal government, state Medicaid programs,
and private insurers have expanded coverage for
virtual health care services. More Medicare
Fee-for-Service (FFS) services are billable as
telehealth during the COVID-19 public health
emergency. In this blog, we shared telehealth
billing guidelines for medical billing specialty
orthopedics. This article will answer basic
telehealth billing questions like How should I
bill telehealth? How to bill for Medicare
telehealth visits? Which procedure codes and
modifiers should I use? What are the restrictions
I should watch out for?    Video Visit
Billing   The CPT codes for virtual video visit
billing are 99201-99215. CPT 99201-99205 are for
new patients while 99211-99215 are for
established patients. We recommend limiting
televisits to established patients. Please note
that American Medical Association CPT rules may
differ from CMS guidelines. It is important to
know which guidelines your commercial carrier is
following. The documentation for these encounters
is the same as in-person requirements (except the
exam). For example, code 99213 requires either
Expanded problem-focused history and low
complexity medical decision-making, or 15 minutes
spent face-to-face with the patient if coding
based on time.   
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Telehealth Billing Guidelines for Orthopedics
Look for additional information to come about
wearables/remote monitoring/sensors, detailed
reimbursement, legal pearls, pitfalls when
scaling, and more. The place of service would be
02 i.e., the location where health services and
health-related services are provided or received,
through a telecommunication system. Telehealth
modifier may vary based on the service provider
i.e., GT modifier used to indicate a service
rendered via synchronous telemedicine GQ
modifier used to report services delivered via
asynchronous telecommunications system modifier
95 used when billing to some private
payers.    Telephone Visit Billing   Telephone
services without face-to-face discussion are not
frequently reimbursed. These codes are not
billable if the call results in the patient
coming in for a face-to-face service within the
next 24 hours or the next available urgent visit.
Medicare wont cover telephone billing codes
(99441 5-10 minutes, 99442 11-20 minutes, and
99443 21-30 minutes). Telephone calls are also
not billable if they refer to an E/M service
performed within the last seven days. Coverage of
telephone calls is not consistent so it is
important to check the coverage and payment for
various payers. 
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Telehealth Billing Guidelines for Orthopedics
Medicare Telehealth Visits   A telehealth visit
is defined as a visit with a provider that uses
telecommunication systems between a provider and
a patient. The HCPCS/CPT codes for common
telehealth services include CPT 99201-99215
(Office or other outpatient visits) CPT
G0425-G0427 (Telehealth consultations, emergency
department or initial patient) CPT G0406-G0408
(Follow-up inpatient telehealth consultations
furnished to beneficiaries in hospitals or
skilled nursing facilities). These visits are
designated for new or established patients. HHS
will not conduct audits to ensure that such a
prior relationship existed for claims submitted
during this public health emergency. Please note
that this billing information is taken from CMS
Medicare Telemedicine Healthcare Provider Fact
Sheet which describes the types of virtual
services for Medicare Beneficiaries. Refer to CMS
for a complete list of telehealth services
payable under the Medicare Physician Fee
Schedule. Virtual Check-in
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Telehealth Billing Guidelines for Orthopedics
Virtual check-in is defined as a brief (5-10
minutes) check-in with your practitioner via
telephone or other telecommunications device to
decide whether an office visit or other service
is needed. A remote evaluation of recorded video
and/or images submitted by an established
patient. The HCPCS/CPT codes for this type of
visit include HCPCS code G2012 and HCPCS code
G2010. These virtual check-in codes are used with
established patients.   E-Visits   This type of
visit is defined as communication between a
patient and their provider through an online
patient portal. The HCPCS/CPT codes for this type
of visit include CPT 99421, 99422, 99423, G2061,
G2062, G2063. These e-visits codes are used with
established patients.   If you still have
confusion over telehealth billing and coding, you
can contact us for more information. Medical
Billers and Coders (MBC) is a leading provider of
orthopedics medical billing and coding services.
Our expertise over orthopedics medical billing
ensures quick and accurate insurance
reimbursements. To know more about our
orthopedics revenue cycle services, contact us
at info_at_medicalbillersandcoders.com/888-357-3226.