A reminder about choosing the proper code for a telehealth visit
Telehealth has helped immensely during the COVID-19 crisis. Insurance companies, although slow to approve payments, joined in to allow us to aid and interact with our patients and their families.
How long this arrangement will last and how long they will waive coinsurance payments is a moving target. The AAP continues to discuss these matters with insurers.
Rules have changed, confusion over which modifiers to use have been resolved and by now we are all familiar with telephone-only CPT codes 99441-3 and our old friends 99212-5 that we used for our "sick visits."
One thing has not changed, though — our fear to use 99214 and 99215, particularly when we cannot actually physically examine our patients.
However, we can still use time as the main factor in choosing the proper code — 10 minutes for 99212, 15 minutes for 99213, 25 minutes for 99214 and 40 minutes for 99215. Remember, you must write down the time: For example, either 9:00 to 9:25, or 25 minutes (99214).
On the other hand, do not forget that until Jan. 1, 2021, if you fulfill two-thirds of the key factors — history, physical examination and medical decision-making — you can still use 99214 with proper documentation.
Here is an example for a patient whose chief symptom is cough:
- A history of present illness (four points needed) should be noted: Duration (2 weeks), severity (mild), quality (dry), modifying factor (albuterol helps).
- At least two systems must be reviewed that were not discussed in the history of present illness.
- Either family history, past history or social history must be discussed.
- The examination needs at least five systems, which through observation could include:
- Skin (rash or cyanosis);
- Ear, nose and throat (nasal alar flaring, rhinitis, postnasal drip);
- Respiratory (hearing audible wheezing or the quality of the cough, ie, croup);
- Muscular/skeletal (retractions); and
- Eyes (coughing so hard the patient has conjunctival hemorrhaging).
- Medical decision-making could require:
- A new diagnosis, which needs additional follow-up and or several new diagnoses, which might not need follow-up;
- Ordering lab work, a chest X-ray and reviewing old notes; and
- Ordering a prescription medication.
Voila! You have a 99214 visit. Remember that after properly documenting your notes, review what you have done and then choose the appropriate CPT code.
For more information:
Richard Lander, MD, FAAP, is in private practice and has been active in the AAP on the business side of medicine. He is an AAP coding trainer and an Infectious Diseases in Children Editorial Board member.