In every issue of Practice Matters, AAAAI coding consultant, Teresa Thompson, CPC, CMSCS, answers coding questions from our members. Coding questions and answers related to COVID-19 can be found below.
Can I bill for telephone encounters?
Yes, provided the visit is with an established patient, parent or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. Refer to payer websites to confirm insurance coverage; if this is not a covered service, the provider should notify the patient, who then may be responsible for payment. Some insurers may require or waive patient co-payments. Review payer policies to verify coverage benefits.
Use codes 99441-99443 for telephone evaluation and management service by a physician or other qualified healthcare professional.
- 99441 – [Telephone evaluation and management service by a physician or other qualified healthcare professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; Five-10 minutes of medical discussion.]
- 99442 – 11-20 minutes
- 99443 – 21 minutes or more
Can CPT® 99211 be billed as a nurse visit for telemedicine?
If the components of CPT® 99211, defined as "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal," are met, this code can be charged. This visit must be documented in the chart notes, and noted as a telehealth visit, place of service 02.*
*Coding for telemedicine services is done using the corresponding codes for an in-person E/M visit, but with the -95 modifier (synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) appended. Place of service should be designated as "02". Some private payers permit telemedicine visits for new patients; check with your private payers. Smart phones with audio and video capabilities may be used during this crisis.
Visit the Utilize Telemedicine: How does billing work? section on our COVID-19 Resources page for more coding information.