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Which code to bill

Sandeep Posted Tue 28th of April, 2020 09:51:43 AM
Our client has mentioned in the medical record that "This visit was provided via telehealth using real-time 2 way audio technology". This patient was established. Client is suggesting to code 99211 - 99215 series of code. Can this encounter be coded with this range of CPTs?
SuperCoder Answered Wed 29th of April, 2020 10:06:54 AM

Thank you for your Question!


As this service was performed via real-time 2 way audio technology not via video technology we have a different set of codes for this service. The type of communication modality for a virtual check-in does not involve face-to-face (F2F) interaction. Rather, patients will bypass the audio-visual means of communication for an audio-only exchange with the provider. This form of service qualifies as telemedicine. Please find the undermentioned codes for this type of service.

  • 99441 (Telephone evaluation and management service by a physician… 5-10 minutes of medical discussion)
  • 99442 (…11-20 minutes of medical discussion)
  • 99443 (…21-30 minutes of medical discussion)


In the interim final rule, CMS indicates that it will reimburse for 99441-99443 during the extent of the COVID-19 PHE. Additionally, both new and established patients qualify for 99441-99443 reporting to both CMS and commercial payers. This means that for Medicare virtual check-ins that extend beyond the 10-minute mark, you should report code range 99442-99443, depending on time spent communicating with patients. Lastly, keep a look out for information on Medicare retroactive billing for code range 99441-99443 that will apply from a specific date in March.


CPT codes 99201-99215 can be billed via telehealth by adding an appropriate modifier but these services should be audio-visual when performed under telehealth. Hence, these codes are not appropriate for audio-only services.


Please find the undermentioned links for more detail.


Hope this Helps!

Sandeep Posted Thu 30th of April, 2020 02:06:24 AM
Our client has specified further as follows: Due to unfavourable condition patient was not not able to connect to the telehealth tool and hence the patient consultation happened via phone. Kindly suggest if we can bill E&M in this scenario considering patient was seen in good faith. How to code in such situation?
SuperCoder Answered Fri 01st of May, 2020 06:26:56 AM

Thank you for your Question!


CMS has implied that they are giving providers flexibility in these extreme PHE circumstances. You can report this service with the appropriate E&M code. CMS is updating coding related guidelines quite frequently due to COVID-19 pandemics. Please check with your Medicare Administrative Contractor (MAC)/ payers for any specific & latest guidelines for these types of cases.


Hope this Helps!

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