telemedicine is the conveyance of clinical administrations through broadcast communications. Telemedicine is a reasonable, helpful route for clinical patients to see their doctors. Time is spared, costs are diminished, commitment is sustained and neither patients nor suppliers pass up eye to eye communications since webcams empower patients and suppliers to see each other continuously. https://prognocis.com/ehr-integrated-telehealth-application/

1. Presenter:Telemedicine 101
What you need to know before you bill Kristen Nehk - VP RCM Services
Stephanie Bulgarino - Senior Manager, RCM Services

2. Types of Telehealth
● Live Video-Conferencing
● Asynchronous Video (AKA Store-and-Forward)
● Remote Patient Monitoring

3. Eligible Providers
https://www.cchpca.org/sites/default/files/2020-
03/CORONAVIRUS%20TELEHEALTH%20POLICY%20FACT%20SHEET%20MAR%2017%202020%203%20PM.pdf

4. What CPT Codes do I use?
New Codes for 2020:
99421: Online digital evaluation and management
service, for an established patient, for up to 7 days,
cumulative time during the 7 days; 5-10 minutes
99422: Online digital evaluation and management
service, for an established patient, for up to 7 days,
cumulative time during the 7 days; 11-20 minutes
99423: Online digital evaluation and management
service, for an established patient, for up to 7 days,
cumulative time during the 7 days; 21 or more minutes

5. Additional Information on 99421-99423
https://codingintel.com/cpt-codes-online-digital-evaluation-and-management-services/

6. What CPT codes do I use?
● If you are using an interactive video or Synchronous telemedicine use 99201-99215
○ 95 Modifier - Synchronous telemedicine service is defined as a real-time interaction
between a physician or other qualified healthcare professional and a patient who is
located at a distant site from the physician or other qualified healthcare professional.
○ GT Modifier - Service was rendered via synchronous telecommunication.
○ GQ Modifier - Services delivered via asynchronous telecommunications.
○ CR Modifier -
■ BCBS of NC - (catastrophe/disaster-related) Only use this modifier for audio-only
visits
■ Medicare - This modifier must be submitted only when an item or service is
impacted by an emergency or disaster

7. Coding Tips
Notes:
(Report 99421, 99422, 99423 once per 7-day period)
(Clinical staff time is not calculated as part of cumulative time for 99421, 99422, 99423)
(Do not report online digital E/M services for cumulative service time less than 5 minutes)
(Do not count 99421, 99422, 99423 time otherwise reported with other services)
(Do not report 99421, 99422, 99423 on a day when the physician or other qualified health
care professional reports E/M services [99201, 99202, 99203, 99204, 99205, 99212, 99213,
99214, 99215, 99241, 99242, 99243, 99244, 99245])
(Do not report 99421, 99422, 99423 when using 99091, 99339, 99340, 99374, 99375, 99377,
99378, 99379, 99380, 99487, 99489, 99495, 99496 for the same communication[s])
(Do not report 99421, 99422, 99423 for home and outpatient INR monitoring when reporting
93792, 93793)

8. What about Phone Consults?
● 99441: Telephone evaluation and management service by a physician or other qualified health care
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 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
● 99442: Telephone evaluation and management service by a physician or other qualified health care
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 7 days nor
leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-
20 minutes of medical discussion
● 99443: Telephone evaluation and management service by a physician or other qualified health care
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 7 days nor
leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-
30 minutes of medical discussion
● Note, not all payers reimburse for this service

9. What is Store and Forward?
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
● Only for established patients
● Informed consent is required
● The provider receives recorded video and/or images remotely from a patient. He
evaluates the material received, analyzes it, and interprets the findings and follows
up with the patient within 24 hours. Report this code only if this service is performed
unrelated to a previous E/M service within the past 7 days, and no related E/M
service or procedure results from this service within the next 24 hours or next
available appointment.

10. How do I set up my Claim?
● Set up a location with place of service 02
● Set up an Encounter type for Telemedicine

11. Location Set up Example

12. CMS 1500 Example

13. Do I have to add anything additional in Progress Note?
● Make sure you have a statement that indicates the service was performed via
Telehealth at the beginning of your progress note
● Indicate the location of the patient, i.e. at home
● Indicate the time spent with the patient
● Ensure that the patient receives a physical exam, when medically necessary,
prior to the telemedicine visit.
● Examination need not be in person if the telemedicine encounter is sufficient to
establish an informed diagnosis
● Follow the same clinical guidelines you would with an in-person visit.
● Use your templates, document the same as you would if the patient was in
person

14. Example of Services
● Allergies
● Cold/Flu
● Diarrhea
● Insect Bites
● Rashes
● Vomiting
● Post operation check in
● and More

15. Can I see a new patient via telemedicine?
https://www.ama-assn.org/system/files/2018-10/ama-chart-telemedicine-patient-physician-relationship.pdf: All states allow a
physician to establish a relationship with a new patient via telemedicine, though state laws differ. A few
states include some caveats to that general rule, restricting the setting in which a patient must be
located in order to establish the patient-physician relationship (e.g. limiting to established medical site),
or the modalities that can be used to establish such a relationship (e.g. telephone versus two-way audio
and video technology). More details on each state’s laws and regulations are available via the link
above.
Example:
A distant site provider who utilizes telehealth medical services must ensure that a provider-patient relationship is
established. At a minimum, this includes the following:
▪ Establishing that the person requesting the treatment is in fact the person he/she claims to be
▪ Establishing a diagnosis through the use of acceptable medical practices, including patient history, an appropriate
physical examination, and indicated diagnostic studies
▪ Discussing with the patient the diagnosis, the evidence for it, and the risks and benefits of various treatment options;
and
▪ Ensuring the availability of appropriate coverage of the patient for follow-up care.

16. Payer Specific Guidelines
● Medicare typically has specific guidelines on who can receive these services, but this was
updated on 03/17/20 and those regulations were lifted during this period.
● BCBS will vary state by state and providers should call their local BCBS
● Tricare does allow but the same referral and pre-auth guidelines apply
● Humana, Aetna, Cigna, and UHC: these are changing especially with the update on 03/17/20 due
to COVID19, we recommend checking payer sites for updates on this.
● Medicaid is state specific and provider should check with their local to get updated guidelines

17. Will my state allow Telemedicine?
● A provider must have a license in the state the patient is
located.
● Each state has their own guidelines on Telehealth, the below
website will provide state by state information
● https://www.cchpca.org/telehealth-policy/current-state-laws-and-reimbursement-
policies?jurisdiction=All&category=128&topic=1https://www.cchpca.org/sites/default/files/2018-
10/CCHP_50_State_Report_Fall_2018.pdf#

18. Can I E-prescribe a controlled substances through
Telemedicine during this public health emergency?
While a public health emergency remains in effect, DEA-registered practitioners may
issue prescriptions for controlled substances to patients for whom they have not
conducted an in-person medical evaluation, provided all of the following conditions
are met:
● The prescription is issued for a legitimate medical purpose by a practitioner
acting in the usual course of his/her professional practice
● The telemedicine communication is conducted using an audio-visual, real-time,
two-way interactive communication system.
● The practitioner is acting in accordance with applicable Federal and State
law.
Provided the practitioner satisfies the above requirements, the practitioner may issue
the prescription using any of the methods of prescribing currently available and in the
manner set forth in the DEA regulations. Thus, the practitioner may issue a
prescription either electronically (for schedules II-V) or by calling in an emergency
schedule II prescription to the pharmacy, or by calling in a schedule III-V prescription
to the pharmacy.

19. Will my state allow me to E-prescribe a controlled
substances through telemedicine during public health
emergency?
There are a number of nuances and differences across the states related to the use of
technology and prescribing.
States may require that a physical exam be administered prior to a prescription being
written, but not all states require an in-person examination, and some specifically
allow the use of telehealth to conduct the exam. Other states have relaxed laws and
regulations around online prescribing.
We highly recommend you contact your State Medical Board to find out what their
policy is on E-prescribing controlled substances through Telemedicine.
**If the state requirements are more stringent than DEA’s regulations, the state
requirements would supersede any less stringent DEA provision.

20. Is patient consent required for Telemedicine?
Informed patient consent may not be required in your state but it is
recommended.
What information should you include on your consent form?
● Inform patients of their rights when receiving telemedicine, including the right to
stop or refuse treatment
● Have a formal complaint or grievance process to resolve any potential ethical
concerns or issues that might come up as a result of telehealth
● Describe the potential benefits, constraints, and risks (like privacy and security)
of telemedicine
● Inform patients of what will happen in the case of technology or equipment
failures during telemedicine sessions, and state a contingency plan
● What they should expect in terms of scheduling, canceling and billing policies
To check what the requirements are in your state, I recommend checking The National
Telehealth Policy Resource Center’s state map. (URL found on resources page) Simply click on
your state and scroll down to the section labeled “Consent.” Here you’ll be able to see whether
state law requires you to get patient consent, and if there are any corresponding
requirements through the state Medicaid program.

21. Resources
DOJ/DEA
https://www.deadiversion.usdoj.gov/coronavirus.html
CMS Fact Sheet on Telemedicine
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-
care-provider-fact-sheet
CMS Frequently Asked Questions
https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-
questions-faqs-31720.pdf
Center for Connected Health Policy/National Telehealth Policy Resource
https://www.cchpca.org/telehealth-policy/current-state-laws-and-reimbursement-policies
Telehealth Coverage Policies In the Time of COVID-19
https://www.cchpca.org/sites/default/files/2020-
03/CORONAVIRUS%20TELEHEALTH%20POLICY%20FACT%20SHEET%20MAR%2017%202
020%203%20PM.pdf
Current State Laws & Reimbursement Policies
https://www.cchpca.org/telehealth-policy/current-state-laws-and-reimbursement-policies