This month, “Spotlight on CPT” will be covering the new Telemedicine Services section in the E&M chapter of CPT. These services are defined as “synchronous, real-time, interactive encounters between a physician or other qualified health care professional (QHP) and a patient utilizing either combined audio-video or audio-only telecommunication”. The synchronous audio-video E&M codes are in range 98000-98007. Synchronous audio-only E&M codes are in the series 98008-98015. For any service that is asynchronous, meaning not performed live in real-time, E&M codes from the Online Digital E&M section (99421-99423) should be used.
Let’s look at the synchronous services in more detail. A ★ next to a code in the CPT Manual indicates a telemedicine code. It also indicates that these telemedicine services and procedures may be reported with modifier 95, Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. Minimally, audio and video must both be used. Appendix P provides a complete listing of these codes.
Synchronous Audio-Video Evaluation and Management Services 98000-98007 are divided like many other E&M services by whether the patient is new or established. Total time for services on the date of the encounter or medical decision making (MDM) may be used to assign the appropriate code.
Synchronous Audio-Only Evaluation and Management Services 96008-98015 are identified with a
indicating an audio-only telemedicine service when appended with modifier 93. Appendix T has a complete listing of these codes. As with the audio-video codes, there is a distinction between visits for new and established patients as well as the use of total time or MDM to determine the code assignment. Please do note that the audio-only codes must exceed 10 minutes of medical discussion in order to assign the code based on time.
There is also another new section in Telemedicine: Brief Synchronous Communication Technology Service (eg, Virtual Check-In) 98016. This code can only be assigned for established patients. 5-10 minutes of medical discussion is required in order to assign this code which is designed to capture a virtual check-in. This occurs when a patient initiates the communication to determine if another E&M service is necessary. Bear in mind, that services of less than 5 minutes are not coded.
The Telemedicine Services section begins with a series of notes regarding telemedicine services. Additional concepts related to these codes are provided in those notes including how to code if an audio-video connection is lost, but the visit was completed with audio-only being restored. Coding professionals would benefit from a review of those notes prior to assignment of codes. Also, a table is available in the CPT manual at this section to provide a snapshot of the telemedicine and non-face-to-face services.
These new codes have required the deletion of codes 99441-99443 for telephone E&M services.
Now, light has been shed on coding telemedicine services.
Synchronous Audio-Video Evaluation and Management Services 98000-98007 are divided like many other E&M services by whether the patient is new or established. Total time for services on the date of the encounter or medical decision making (MDM) may be used to assign the appropriate code.
Synchronous Audio-Only Evaluation and Management Services 96008-98015 are identified with a
indicating an audio-only telemedicine service when appended with modifier 93. Appendix T has a complete listing of these codes. As with the audio-video codes, there is a distinction between visits for new and established patients as well as the use of total time or MDM to determine the code assignment. Please do note that the audio-only codes must exceed 10 minutes of medical discussion in order to assign the code based on time. There is also another new section in Telemedicine: Brief Synchronous Communication Technology Service (eg, Virtual Check-In) 98016. This code can only be assigned for established patients. 5-10 minutes of medical discussion is required in order to assign this code which is designed to capture a virtual check-in. This occurs when a patient initiates the communication to determine if another E&M service is necessary. Bear in mind, that services of less than 5 minutes are not coded.
The Telemedicine Services section begins with a series of notes regarding telemedicine services. Additional concepts related to these codes are provided in those notes including how to code if an audio-video connection is lost, but the visit was completed with audio-only being restored. Coding professionals would benefit from a review of those notes prior to assignment of codes. Also, a table is available in the CPT manual at this section to provide a snapshot of the telemedicine and non-face-to-face services.
These new codes have required the deletion of codes 99441-99443 for telephone E&M services.
Now, light has been shed on coding telemedicine services.
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