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Pain Management Coding Alert

Reader Question:

CMS Sets Out New Telehealth Guidance

Question: Can you tell me if there's anything new going on in telehealth coding for 2018? I haven't heard much.

Texas Subscriber

Answer: The Centers for Medicare and Medicaid Services (CMS) continues to invest in telehealth as Medicare moves beyond the traditional venues to more alternative settings for enhanced patient care. However, a recent fact sheet noted that stakeholder input was mixed on the new options, as some clinicians felt the codes don't support new technologies or are too broad to be fully realized.

New codes: The Medicare physician fee schedule (MPFS) finalized the following CPT® and HCPCS codes for telemedicine in 2018:

  • HCPCS code G0296 (Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making);
  • CPT®  code +90785 (Interactive Complexity...);
  • CPT® codes 96160 and 96161 (...Health Risk Assessment...);
  • HCPCS code G0506 (...Care Planning for patients requiring Chronic Care Management...); and
  • CPT® codes 90839 and 90840 (Psychotherapy for Crisis...).

Extras: CMS dropped the GT modifier (Via interactive audio and video telecommunication systems) and will no longer require it for telehealth claims. "Anytime a billing requirement is removed, it is positive- one less regulation to potentially 'trip over,'" says Vinod Gidwani, founder and president of Currence Inc. in Skokie, Illinois (medcurrence.com). "Telemedicine will continue to expand and its potential to bend the cost curve is one of the positive innovations taking place inhealthcare."

The MPFS also noted that CPT® code 99091 (Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time), which was bundled with other codes in the past, will be revalued and paid separately now.