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Billing in Compliance with Recent Telehealth Waivers

On January 30, 2020, the World Health Organization ("WHO") declared the 2019 Novel Coronavirus ("2019-nCoV") disease outbreak a public health emergency of international concern, and on March 11, 2020, the WHO officially declared the Coronavirus Disease ("COVID-19") a pandemic.

As a result of these declarations, the WHO established a new International Classification of Diseases, Tenth Revision ("ICD-10") emergency code, U07.1 2019-nCoV acute respiratory disease.  The Centers for Disease Control ("CDC") announced the new code will be effective and can start being assigned April 1, 2020.  Until the new code is in effect, providers should assign code B97.29 as a secondary code to confirmed cases of COVID-19.  For example, providers should use a symptom code for R50.9 fever and B97.29 Other Coronavirus as the cause of diseases classified elsewhere. As of April 1, 2020, providers should assign code U07.1 2019-nCoV acute respiratory disease to all confirmed cases of COVID-19.

To date, the most frequently used ICD-10 codes related to COVID-19 include: 

  • Pneumonia: For a pneumonia case confirmed as due to COVID-19, assign codes J12.89, Other viral pneumonia and B97.29.

  • Bronchitis: For a patient with acute bronchitis confirmed as due to COVID-19, assign codes J20.8, Acute bronchitis due to other specified organisms, and B97.29.  For a patient with bronchitis not otherwise specified confirmed as due to the COVID-19, use codes J40, Bronchitis, not specified as acute or chronic, and code B97.29.

  • Respiratory Infection: If the confirmed COVID-19 is documented as being associated with lower respiratory infection, not otherwise specified, or an acute respiratory infection, use codes J22, Unspecified acute lower respiratory infection, with code B97.29. If the confirmed COVID-19 is documented as being associated with respiratory infection, not otherwise specified, use codes J98.8, Other specified respiratory disorders, with code B97.29.

  • Acute Respiratory Distress Syndrome ("ARDS"): ARDS confirmed due to COVID-19 use codes J80, ARDS, and B97.29. 

For patients who present with a concern of exposure to COVID-19, but exposure is ruled out after evaluation, providers should use code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. If there is actual exposure to someone who is confirmed to have COVID-19, providers should use code Z20.828, Contact with and suspected exposure to other viral communicable diseases. 

If a provider documents "suspected", "possible", "probable", or "rule out", code B97.29 should not be assigned. Instead, a provider should assign a code explaining the reason for the encounter, such as fever. If a patient presents with signs and symptoms, and a definitive diagnosis has not been established, a provider should assign the appropriate codes for each of the presenting signs and symptoms. 

Providers should not use diagnosis code B34.2, Coronavirus infection, unspecified, because the cases of COVID-19 have been respiratory in nature, so the site is not unspecified. 

Billing for Medicare Telehealth Services

The Centers for Medicare & Medicaid Services ("CMS") and the Department of Health and Human Services ("HHS") have issued recent waivers that affect how telehealth services are delivered and paid for by Federal government payers.  Under the recently issued Section 1135 waivers, Medicare telehealth services should be billed as if the service had been furnished in-person.  The claim should reflect the designated Place of Service (POS) code 02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site. 

Medicare typically reimburses providers for three types of telemedicine visits – (1) telehealth visits, (2) virtual check-ins, and (3) e-visits.

Virtual check-ins are a short patient-initiated brief communication for an established patient, for an established diagnosis.  To bill virtual check-ins, providers should use HCPCS codes: 

  • G2012: Brief communication technology-based service by a physician or other qualified clinician who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 

  • G2010: 5-10 minutes of medical discussion - 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 seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. Established patients only – same definition as for other E&M services. Verbal consent required – documented in the patient's medical record. No service-specific documentation requirements but medical necessity must be documented. May only be billed by those providers who can perform/bill E&M services.

E-visits include internet-based or email and patient portal communications.  To bill e-visits, providers should use codes: 

  • 99421-99423: Online medical evaluation services are non-face-to-face encounters originating from the established patient to the physician or other qualified clinician for evaluation or management of a problem utilizing internet resources. The service includes all communication, prescription, and laboratory orders with permanent storage in the patient's medical record. The service may include more than one provider responding to the same patient and is only reportable once during seven days for the same encounter. 

  • 99421 – 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the seven days

  • G0425-G0427: Telehealth consultations, emergency department or initial inpatient

  • G0406-G0408: Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs

  • Office or other outpatient visits 99201-99215 for new and/or established patients. 

Telehealth visits for new or established patients should be billed using the following codes: 

  • 99201-99215 (Office or other outpatient visits) Remember that established patient visits only require 2/3 key components when assigning a follow-up visit code.  

  • G0425-G0427 (Telehealth consultations, emergency department or initial inpatient)

  • G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs).

Finally, laboratories may bill for the Novel Coronavirus Real-Time RT-PCR Diagnostic Test Panel test using the newly created HCPCS code (U0001) beginning April 1, 2020, along with the appropriate diagnosis codes as documented by the provider. 

Medicaid

States have the option to determine whether and what types of telemedicine to cover under Medicaid. Therefore, providers should check with their state Medicaid program regarding telehealth waivers and billing compliance. 

Commercial Payers

Commercial payers have different requirements for submitting bills for telemedicine visits.  Providers should check each payer's website for updates to ensure compliance with billing requirements.  Specifically, providers should review effective dates, as most insurers are limiting telemedicine exemptions to a specific period of time; services covered; the use of telehealth versus office visit codes, and what modifiers are necessary. ​​​

Copyright © 2020 Womble Bond Dickinson (US) LLP All Rights Reserved.National Law Review, Volume X, Number 85

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About this Author

Ashley McGlone healthcare Attorney Womble Bond Dickinson Law Firm Winston-Salem NC
Senior Counsel

Ashley is a seasoned healthcare attorney with nearly a decade of experience advocating on behalf of healthcare providers. She brings a wealth of industry knowledge and personal insight into the regulatory and operational challenges facing healthcare clients.

Ashley advises clients on issues related to government health payment programs under Medicare and Medicaid.  Her areas of substantive focus include physician reimbursement, quality and cost program reporting requirements, health information technology, and Alternative Payment Models.  Ashley...

336.747.6614
Lori Baker Charlotte Director Of Healthcare Consulting
Director Of Healthcare Consulting

Lori Baker is not licensed to practice law. Her activities are directly supervised by attorneys licensed to practice law in the firm’s Winston-Salem office.

As a healthcare consultant with 20+ years of diverse and extensive industry experience, Lori collaborates with clients on nearly every area of their businesses. She advises clients on provider coding and documentation education, coding assessments, appeal assistance and expert testimony. Lori has provided extensive coding and billing advice and assistance to hospitals and physicians as it relates to behavioral health and post-acute services.

704-444-2922