Covid 19 Coding UpdateMarch 18, 2020, 12:25 AM | by: David Williams | No Comments
COVID 19 Coding Update
Frequently Asked Questions (FAQs)
- What are Virtual Check-Ins? Officially titled “Brief Communication Technology-Based Service, e.g. Virtual Check-In.” Virtual Check-In is defined as “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 (E/M) 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).”
- What Modality is Allowed? CMS stated the code allows “audio-only real-time telephone interactions (Note: telephone calls that involve only clinical staff cannot be billed using HCPCS code G2012 since the code explicitly describes (and requires) direct interaction between the patient and the billing practitioner.)
- Is There a Patient Co-Payment for Virtual Check-Ins? Yes, as a Medicare Part B service, the patient is responsible for a co-payment for the service
- Is Patient Consent Required? Patient consent is required for this service, due in part to the fact that there is a patient co-pay. CMS stated that written consent is not required; a practitioner can obtain the patient’s verbal consent and note that in the medical record for each billed service (i.e. every time the patient wants to obtain a virtual check-in).
- Are There Any Patient Restrictions? CMS limits this code to established patients only. CPT defines an established patient as one who has received professional services from the physician or qualified health care professional or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years.
- Who Can Deliver Virtual Check-Ins? Virtual Check-Ins can be delivered only by those practitioners authorized to furnish E/M services. This service is meant to describe, and account for the resources involved, when the billing practitioner directly furnishes the virtual check-in. Accordingly, only physicians and qualified health care professionals are allowed to bill for this service.
- Are There Any Frequency Limits? There is no frequency limitation on this code.
- Are There Any Timeframe Limitations?
- If the Virtual Check-In originates from a related E/M service provided within the previous 7 days by the same physician or other qualified health care professional, then the service is considered bundled into that previous E/M service and G2012 would not be separately billable (provider liable). In that event, do not bill either the patient or the Medicare program for that code.
- If the Virtual Check-In leads to an E/M service with the same physician or other qualified health care professional within the next 24 hours or soonest available appointment, then this service is considered bundled into the pre- or post-visit time of the associated E/M service, and therefore, would not be separately billable (provider liable). In that event, do not bill either the patient or the Medicare program for that code.
- What are the Documentation Requirements? There are no service-specific documentation requirements for Virtual Check-Ins (other than documenting the patient’s consent, of course). Documentation for Virtual Check-Ins is consistent with the requirements for other Medicare covered physician services. (normal evaluation and management service).
- Are There Any Patient Location Requirements? The patient need not be located in a rural area or any specific originating site. The patient can be at home. Virtual Check-Ins are not considered a Medicare telehealth service.
- What POS should be used? 12 HOME
- What diagnosis code? For patients presenting with any signs/symptoms and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: Cough (R05); Shortness of breath (R06.02) or Fever unspecified (R50.9). For cases where there is possible exposure to COVID-19, but the disease is ruled out, report code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. For cases where there is an actual exposure to someone who is confirmed to have COVID-19, report code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. This code is not necessary if the exposed patient is confirmed to have COVID-19.