The Optometrist’s Guide to Performing and Billing Telehealth Exams during COVID-19
In a time of crisis, where routine exams and contact lens fits are considered to be non-essential, many eye care providers are scrambling to find ways to at least keep a little bit of cash flow going for their practices. While delivery and curbside material pickup gives a slight boost, many practitioners are wondering how they can still see emergency and problem-focused patients in the safest way possible.
Enter Telehealth and Telemedicine.
Seeing patients remotely by utilizing camera technology on phones, computers and tablets is actually not new. However, during the current pandemic, many eye care providers may find themselves adopting Telehealth as a new way to evaluate emergency cases.
Here is a quick guide on performing Telehealth exams and billing them.
What Hardware Do I Need?
Your patient will obviously need a device with video and camera capabilities. The higher pixel rate/resolution, the better. You will need a computer with your EHR software to document findings and treatment.
What Software Do I Need?
- If you already have access to a HIPAA-compliant Telehealth program such as EyeCareLive, continue using it. If you do not, you can consider purchasing one of these programs or you can use more common video messaging programs...
- Thanks to President Trump signing emergency legislation and a 1135 waiver utilized by CMS, requirements have been relaxed on Telehealth exams - utilization of video conferencing technologies such as Facetime, Skype, Google Hangouts Video, Facebook Video Chat or Zoom are acceptable during these times of crisis
- Avoid using any conferencing interfaces that could involve other individuals such as Facebook Live, Tik Tok or Snapchat
- It is not required, but is recommended, that you notify patients if you are using a software that is not normally considered HIPAA-compliant
"Thanks to President Trump signing emergency legislation and a 1135 waiver utilized by CMS, requirements have been relaxed on Telehealth exams - utilization of video conferencing technologies such as Facetime, Skype, Google Hangouts Video, Facebook Video Chat or Zoom are acceptable during these times of crisis"
Can I see both New and Existing Patients?
Technically you are only supposed to see existing patients. However, the 1135 waiver states that you will not be audited to ensure that a patient was existing. Take home point: tread carefully.
What Types of Services Can I Offer Through TeleHealth?
- Virtual Check In - The patient briefly checks in with the practitioner virtually to see if an office visit or some other service is needed.
- E-Visits - The patient has an online visit and communication with the ECP
- Medicare Telehealth Visit - Like an E-Visit, but specific to Medicare
How do I Code & Bill for Telehealth Virtual Check Insurance?
Virtual Check Ins will fall under codes G2012 or G2010. Basically, G2012 relates to communicating with a patient while G2010 relates to evaluating a picture or video sent by the patient. Here is how CMS defines these codes:
- G2012
- Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
- Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
- G2010
- Remote evaluation of recorded video and/or images submitted by an established patient (e.g, store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment
How do I Code + Bill for Telehealth E-Visits?
Telehealth E-Visits will fall under a variation of codes indicating time spent in Telehealth consultation with a patient based on if a provider can bill E/M services or not.
Remember that your staff’s time with the patient does NOT count towards the total time.
"Technically you are only supposed to see existing patients. However, the 1135 waiver states that you will not be audited to ensure that a patient was existing. Take home point: tread carefully"
If a Provider CAN bill E/M services, these CPT codes can be used:
If a Provider CANNOT bill E/M services, these HCPCS codes can be used:
-
99421 = 5-10 minutes
-
99422 = 11-20 minutes
-
99423= 21+ minutes
-
G2061= 5-10 minutes
-
G2062 = 11-20 minutes
-
G2063 = 21+ minutes
How do I code + Bill for Medicare Telehealth Visits?
99201-99215: Can be used for Telehealth exams with a -95 modifier. The same billing criteria used for in-office visits applies when utilizing these codes.
G0425-G0427: can be utilized for emergency Telehealth consultations. Full time stipulations and definitions by CMS are listed below:
- G0425 - Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via Telehealth
- [problem-focused history, problem-focused examination, straightforward medical decision making (MDM)]
- [problem-focused history, problem-focused examination, straightforward medical decision making (MDM)]
- G0426 - Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via Telehealth
- [detailed history, detailed examination, moderate complexity MDM]
- [detailed history, detailed examination, moderate complexity MDM]
- G0427 - Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via Telehealth
- [comprehensive history, comprehensive examination, high complexity MDM]
- [comprehensive history, comprehensive examination, high complexity MDM]
G0406-G0408 can be utilized for in patient follow up care at a skilled nursing facility or hospital. These are out of scope for most private practice owners and thus will not be discussed.
What am I getting Paid for these Codes?
Virtual Check-In Fee Payments
E-Visits Fee Payments
Medicare Telehealth Visits Fee Payments
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G2012=$14.80
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G2010= $12.27
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99421= $15.52
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99422= $31.04
-
99423= $50.16
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G2061= $12.27
-
G2062= $21.65
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G2063= $33.92
-
99201-99215 =Are per usual
Can I use 920XX codes for Telehealth?
No - these are not allowed.
What about TELEPHONE ONLY consults?
The general consensus is that telephone only consults (no video or picture) cannot be billed. However if you must try, the code G2012 will be your best bet based on definition.
Important Tips to Remember:
- Always document findings and history as you would with a regular office visit - remember that you are using digital video/photography, not a slit lamp/biomicroscope
- Utilize E-prescribing or call in prescriptions to help maintain social distancing
- When billing Medicare, remember to change your place of service from 11-Office to 02-Telehealth
- Utilize a -95 modifier on your CPT codes to distinguish the exam as Telehealth
The info on Telehealth is changing constantly as demand increases due to many patients choosing to stay home due to perceived susceptibility to COVID-19. If you have an outside biller, make sure to contact them and ask any questions that may arise. We will do our best to keep this page up-to-date. We wish you luck during this trying time!
"The info on Telehealth is changing constantly as demand increases due to many patients choosing to stay home due to perceived susceptibility to COVID-19. If you have an outside biller, make sure to contact them and ask any questions that may arise."
Want more Additional Information: Check out these useful articles/Resources
- Medicare CMS Telehealth Services Guide
- Telehealth Expansion and Communication Based Tech Services (David A. McKenzie, CAE ACEP Reimbursement Director)
- How to Get Paid for Patient "e-Visits" under the 2020 Medicare Physician Fee Schedule
- Use of E-Visit Codes for Medicare Part B Services During Coronavirus/COVID-19
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