Telemedicine has become an integral part of the healthcare system. Especially after the COVID-19 pandemic, and advancements in technology. Medical care has become convenient and easily accessible irrespective of location. Now, medical care can be provided in remote areas including consultations, diagnosis, and treatments. In this blog, we will learn about what telemedicine is, its benefits and limitations. We will also learn about the common CPT codes that are used in telemedicine for error-free billing and reimbursement.
What Is Telemedicine?
Telemedicine is the practice of providing medical consultation remotely using telecommunication technology such as video calls, or voice calls. Patients are not required to visit the healthcare provider’s office. Telemedicine is applied in various aspects including initial consultations, follow-up, mental healthcare services, chronic disease management, and post-operative care.
Telemedicine is of two types:
- Synchronous (Real-time) Telemedicine: The real-time interaction between the healthcare provider and patient. It includes video calls, voice calls, and real-time chats.
- Asynchronous (Store-and-Forward) Telemedicine: The patient sends information via image or text to the healthcare provider to review it later and provide feedback on ongoing medical conditions.
Benefits of Telemedicine
Telemedicine has numerous benefits. It has significantly improved medical care services for both the patient and the providers. Let’s take a look at the benefits of telemedicine:
- Expand Access to Care: Telemedicine is accessible in remote rural areas for those who cannot commute to the doctors. It has removed the geographical barrier.
- Convenience for Patients: Patients can access medical care conveniently from their homes without stepping out of their homes. It saves time and stress.
- Reduce Exposure to Diseases: Telemedicine has helped in public health emergencies such as pandemics. It reduces the risk of patients being exposed to infectious diseases while visiting the hospital or other medical facilities in person.
- Cost Savings: It has significantly reduced costs for both healthcare providers and patients.
Common Telemedicine CPT Codes
Telemedicine has brought ease to the landscape of the medical industry. Additionally, CPT (Current Procedural Terminology) codes refine the medical billing and reimbursement process. These codes indicate the type of service provided to the patient in each session and the patient’s eligibility for those services:
Here is a breakdown of common CPT codes used in telemedicine:
| Remote Patient Monitoring CPT Codes | ||
| Telehealth Visits | ||
| CPT Coded | Place of Occurrence | Patient’s Eligibility |
| 99202 – 99215 | Office or other outpatient visits. | For both new and established patients depending on the complexity and duration |
| G0425 – G0427 | For consultations, emergency department, and initial inpatient | For both new and established patients depending on the complexity and duration |
| Virtual Check-Ins | ||
| G2010 | Remote evaluation of recorded videos or images | Established patient |
| G2012 | Remote evaluation of recorded videos or images that the patient sent for consultation and further treatment plan | Established patient |
| G2252 | Remote evaluation of recorded videos or images that the patient sent for consultation and further treatment plan | Established patient |
| Virtual Check-Ins (If the providers cannot independently bill for E/M services) | ||
| G2250 | Review and prescribe treatment plan of recorded text and images within 24 hours | Established Patient |
| G2251 | Remote assessment of patient’s recorded images or videos to prescribe treatment | Established Patient |
| Virtual Visit | ||
| 99421 – 99423 | Online digital evaluation of patients for up to 7 days | Established Patient |
| G2061 – G2063 | Online assessment by non-physician healthcare provider | Established Patient |
| Telephone Services | ||
| 99441 –99443 | Healthcare providers review and manage patient’s care and report the services to the patient’s guardian. | Established Patient |
| Interprofessional Telephone/ Internet/ Electronic Health Record Consultation | ||
| 99446 – 99449 | A consultative doctor provides an assessment and manages the patient’s care, then shares a report with the doctor who referred the patient. The service also includes time for talking about the patient’s case and reviewing their information. | |
| 99451 | A consultative doctor assesses and manages the patient’s care, and then sends a written report to the patient’s main doctor. The service includes at least 5 minutes of discussion about the patient’s case. | – |
| 99452 | The doctor or healthcare professional refers the patient to another specialist or service. The referral takes about 30 minutes. | – |
| Telemedicine Services | ||
| G0406-G0408 | Inpatient follow-up via telehealth | Established Patient |
| G0425-G0427 | Telehealth Consultation or emergency department | New Patient |
| G0508, G0509 | Telehealth Consultation or critical care | New and established patient |
Billing and Reimbursement for Telemedicine With CPT Codes
Telemedicine is comparatively less hassle-free than in-person visits. However, billing and reimbursement are complex for telemedicine. Healthcare professionals and providers must use accurate CPT codes to prevent billing errors and accurate reimbursement. For telemedicine, every insurer has their reimbursement policies based on the patient’s location and the type of services
- Insurance Providers: For telemedicine, every insurer including Medicare, Medicaid, and private insurers has different policies for reimbursement. Healthcare providers must stay updated with the latest guidelines.
- State-Specific Regulations: Telemedicine policies also vary as per the state. Only some states have expanded the coverage for telemedicine under Medicaid. The healthcare provider must check the regulations of their respective state.
Legal and Regulatory Considerations for Telemedicine
- State Licensure Requirements: Healthcare providers can provide services to the patient only if they have a license in that state. It can be a barrier to providing telemedicine service.
- HIPAA Compliance: All telemedicine services must comply with the Health Insurance Portability and Accountability Act (HIPPA). It ensures that the patient data is fully confidential and protected.
- Prescribing Medications: Healthcare providers must be aware of the federal and state laws governing telemedicine prescriptions. Certain medications especially controlled substances are restricted to prescription via telemedicine.
Limitations of Telemedicine
Telemedicine is a convenient and reliable option to cater to a wide area to provide medical services. However, telemedicine has its own set of limitations listed below:
- Technological Barriers: The patient may not have access to a reliable internet connection. Also, sometimes patients are not familiar with digital consultation.
- Limited Scope for Certain Conditions: Not all medical emergencies can be treated through telemedicine. Many medical conditions such as physical injuries, lab tests, or others require in-person visits.
- Legal and Regulatory Issues: Each state’s law must also taken into consideration before providing telemedicine services.
Common Telehealth Billing Mistakes And How to Avoid Them
Telehealth billing is complex and can often lead to errors, payment delays, and denials. Here are common telehealth mistakes and how you can avoid them:
1. Using Incorrect CPT Codes
The most commonly occurring error in medical billing is using incorrect and outdated CPT codes. Telemedicine has its own set of codes that differs from in-person consultation codes.
How to Avoid: Healthcare providers must double-check the CPT code guidelines. Every code indicates one specific service. Keep track of each billing code and its right usage.
2. Failing to Confirm Patient Eligibility: Not all patients are eligible for the same category of service. Also, insurers have different policies and regulations regarding telemedicine.
How to Avoid: Always double-check the patient’s eligibility for telehealth service. It also involves checking insurance policies and confirming from the respective insurer.
3. Not Maintaining Proper Documentation: Improper documentation can lead to claim denial and audits.
How to Avoid: Make your the documentation is proper and has accurate information. It must have a date, time, type of consultation, medical history, and summary of treatment provided via telehealth service.
4. Not Adhering to HIPAA Compliance: using a non-HIPPA compliant platform or failing to protect patient confidentiality leads to both legal penalties and reimbursement issues.
How to Avoid: Use only those platforms that are HIPPA-compliant and offer security and data confidentiality.
The Future of Telemedicine Integration with CPT Codes
The future of telemedicine with its integration with CPT will bring both opportunities and challenges. Here is what the future of telemedicine will look like:
- Telemedicine Expansion: Telemedicine services are expected to expand in underserved and rural areas so a large number of patient can get medical care in their homes.
- CPT Code Adaptation: New CPT codes will be developed to cater to more services such as virtual consultation, remote monitoring, and AI-based healthcare.
- Reimbursement Complexity: Navigating the diverse policies of every insurer can become a key challenge for coders and telemedicine providers.
- Technology Integration: New advancements in technology and the use of AI require accurate CPT codes to avoid any errors and denials.
- Interdisciplinary Collaboration: Telemedicine will collaborate across various healthcare providers. It will require comprehensive documentation for all the remote areas.
Frequently Asked Questions (FAQs)
1. What is the difference between synchronous and asynchronous telemedicine?
Synchronous telemedicine is real-time video call communication between the healthcare provider and patient. Whereas, asynchronous telemedicine is a communication where patients send their information through photos and text to the provider for later review.
2. Can telemedicine be used for mental health services?
Yes, telemedicine is widely used to provide mental health services including therapy, sessions, counseling, and psychiatric evaluations.
3. Are telemedicine consultations covered by insurance?
Telemedicine insurance varies as per the provider’s policy. Many insurers expanded coverage during the COVID-19 pandemic. However, it is recommended to verify whether the insurer covered the service or not.
4. Do telemedicine consultations cost the same as in-person visits?
It depends on the insurer, the type of service, and the healthcare provider’s pricing structure. In some cases, telemedicine consultation can be less expensive than in-person visits.
Conclusion
To conclude, telemedicine has significantly transformed the landscape of the healthcare industry. CPT codes are an integral part of ensuring a smooth reimbursement and billing process. Through telemedicine, healthcare providers can expand the access to people to receive medical care over video calls. Additionally, the use of accurate CPT codes prevents errors and delays in billing and reimbursement.
