Telemedicine has made inroads into the medical area, by bringing specialist care to very rural areas, anywhere in the world. This type of technology allows a two-way real-time communication between the rural provider and a specialist consultation that is not nearby.
Telemedicine has provided many benefits to those in a rural setting, to have access to specialty care throughout the world.
Coding for telemedine is a new challenge. CMS (Medicare) will pay for selective telehealth/telemedicine services. CMS states that they will reimburse for the use of a telecommunication as a substitute for a face-to face encounter. However, they will only reimburse if the ‘originating’ site is in a rural health professional shortage area (HPSA). Telemedicine is considered investigational by some 3rd party carriers, and may not be reimbursed. If that is the case, then the patient would ultimately be responsible for those charges.
Payment and coverage of telemedine/telehealth services requires an interactive audio and video telecommunication system that allows real-time processing with communication between the provider at the rural health site, and the provider (consultant) at the distant location.
Below is a listing of the type of services utilizing telemedicine/telehealth. This is not an all-inclusive listing.
§ Office/outpatient office visits
§ Individual psychotherapy
§ Pharmacologic management
§ Psychiatric diagnostic interview examinations
§ End Stage Renal Disease Services (ESRD)
§ Medical Nutrition Therapy
§ Radiology Interpretation Services
§ Cardiac medicine services
For coding of these services HCPCS provides the most comprehensive listing of service codes to be reported. However, modifiers also play a part in this too. As a coder if you are reporting with HCPCS the listing below is a methodology to report consultations, and follow up services in an inpatient setting.
Follow-up inpatient telehealth consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth (new 1-1-2009)
Follow-up inpatient telehealth consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth (new 1-1-2009)
Follow-up inpatient telehealth consultation, complex physicians typically spend 35 minutes communicating with the patient via telehealth (new 1-1-2009)
Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a CORF qualified social worker or psychologist in a CORF) (new 1-1-2009)
Initial inpatient telehealth consultation, typically 30 minutes communicating with the patient via telehealth (new 1-1-2010)
Initial inpatient telehealth consultation, typically 50 minutes communicating with the patient via telehealth (new 1-1-2010)
Initial inpatient telehealth consultation, typically 70 minutes or more communicating with the patient via telehealth (new 1-1-2010)
Telehealth originating site facility fee
Telehealth transmission, per minute, professional services bill separately
If you are in the outpatient setting you need to use the modifiers GT & GQ.
GQ Via asynchronous telecommunications system
GT Via interactive audio and video telecommunication system
As a provider of telehealth services, a GT modifier will need to be appended to the professional fee code (either CPT code(s) or HCPCS code). These modifier codes would be added to the standard evaluation and management codes, or to what would normally be billed for a visit that is an actual face-to-face visit with the provider.
If the evaluation service includes a provider reviewing the medical record(s), then no separate billing may be submitted for a record review. Medical record review is already included in consultation/evaluation services per CPT guidelines.
If the telecommunications service is provided by asynchronous telecommunications, then the GQ modifier would need to be appended. An example of the asynchronous technology is a service such as an ultrasound, or MRI performed, then sent to a distant location/provider for interpretation/consultation. This technology is not actual real time face to face, but “store and forward” for use by the consultant.
In some cases an insurance payer will pay for the usage of the telecommunication equipment if you are the originating site. Billing for this service, can be submitted with HCPCS code Q3014 on your claim form. In addition, some carriers may even pay for telehealth transmission “per minute” by usage of HCPCS Code T1014.
At this time, telemedicine is still a relatively new process and new codes are emerging all the time. This link below is very helpful -