The DEF is providing updated information for healthcare professionals working during this time. Here are some helpful tips from DEF Advisory Council member Leigh Ann Pansch. Stay safe and healthy!
Please always follow the guidance given by your dermatology office management team. We have provided some guidelines for documenting the patient visit for telehealth that we hope will be useful. We have also attached the AAD Practice Management Guidelines for dermatology billing codes as a quick reference guide.
Some telehealth visits are taking place using Skype, FaceTime, Zoom, Duo, and other services. Whenever possible, it’s great to include your MA on the telehealth visits to help document the interaction.
- If you conduct a real-time visit via FaceTime, Skype, Zoom, Duo, etc., this may be billed as a standard E/M (99201-99214). While there are requirements that there be a pre-existing relationship with the patient in order to conduct Telehealth visits, CMS has temporarily waived this requirement and the OIG will not investigate these visits during the COVID-19 emergency. In other words, if you have a new patient that wants to be seen for something urgent, you may see them using Telehealth. Please document that the visit took place at the “Telehealth” location and note in the HPI that the visit was performed using FaceTime/Duo/Skype/Etc., and that verbal consent to treat was given by the patient.
- Regarding store-and-forward:
- An email sent by the patient is not billable unless it results in a phone call to discuss a diagnoses with the patient. This is considered a virtual check-in and is billed to Medicare as G2012 and to other payers as (99441-99443) for Physicians (5-10 minutes, 11-20 minutes, and 21-30 minutes respectively) and (98966-98968) for Non-Physician Providers (5-10 minutes, 11-20 minutes, and 21-30 minutes respectively). [see below for digital E/M information]
- A prescription refill is not billable unless, again, it results in a phone call to discuss a diagnosis with the patient. This is considered a virtual check-in and is billed to Medicare as G2012 and to other payers as (99441-99443) for Physicians (5-10 minutes, 11-20 minutes, and 21-30 minutes respectively) and (98966-98968) for Non-Physician Providers (5-10 minutes, 11-20 minutes, and 21-30 minutes respectively).
- The patient submits a photo/video through their portal/email/ pocket patient app/etc. If you evaluate the image and determine if the patient needs an in-person appointment, this is reported with G2010. [see below for digital E/M information]
- According to the American College of Physicians, if an established patient initiates a virtual check-in, we may give them the option to proceed with a “digital visit.” If they respond that they would like to proceed digitally, we can conduct a digital E/M (99421-99423). These services are not for the non-evaluative electronic communication of test results, scheduling of appointments, or other communication that does not include E/M. Patients must initiate these services through HIPAA-compliant secure platforms, such as electronic health record (EHR) portals, secure email, or other digital applications which allow digital communication with the clinician. Copays will apply, the patient must be informed, and the information documented in the chart. Audio and Video can be used, but not a traditional telephone. Do not report these codes on the same day that the Provider is reporting Standard E/M (99201-99214) services. This means that if you see a patient in-office or via FaceTime/Skpye/Duo and report the normal E/M, you cannot report the (99421-99423) codes for that day.
**Please note that no regulations have been lifted for the 99441-99443/99421-99423/98966-98968/G2010/G2012 codes with regard to an existing relationship. These can only be used for established patients and are most often patient-initiated.
In short, a standard E/M is billable for Telehealth if we are seeing the patient via real-time video conferencing (with audio) and are documenting that the patient gave verbal consent.