CMS Clarifies Risk Adjustment Criteria for Coding Telehealth Services
CMS clarified on April 10, 2020 that they permit coders to submit ICD-10-CM diagnoses codes for Risk Adjustment from telehealth services; this is as long as it meets the set criteria (i.e. inpatient, outpatient, or professional service and from a face-to-face encounter) (CMS, 2020). CMS is stating that telehealth services can meet the face-to-face requirement “when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication” (2020). Read the full announcement here.
Changes to Risk Adjustment
Learn about Risk Adjustments and HCC Basics from YES Education: Overview of Risk Adjustment and Hierarchical Condition Categories (HCC). Key concepts, Outline HHS and CMS Models, Risk Adjustment. Documentation and Coding Practices, Auditing and Monitoring. 1 AHIMA & AAPC CEU.
From a medical coding and billing standpoint, the change in the coding telehealth services criteria for risk adjustment is causing updates to how these services are billed, modifying the applicability of diagnoses from telehealth services for risk adjustment. Previously, the Medicare-enrolled originating site was allowed to bill Medicare for a facility fee with code Q3014. Now, coders may not apply a facility fee if the originating site is at the patient’s home (Center for Connected Health Policy, 2020).
In addition, modifiers give further information to correctly bill payers for the correct amount. Additionally, this includes using G0 to identify telehealth services for diagnosis, evaluation, or treatment of acute stroke symptoms (Center for Connected Health Policy, 2020). You can view additional codes and modifiers for telehealth services in the PDF provided by Center for Connected Health Policy.
The HHS Office of Inspector General is allowing providers to reduce or waive cost-sharing for the telehealth visits that would be paid for by federal healthcare programs (CMS, 2020). You can view additional blanket waivers for providers from CMS here.
Don’t miss out on this opportunity to continue reporting your Risk Adjustment diagnoses!
Patients need telehealth services now more than ever due to the COVID-19 outbreak. Because of this, providers are ramping up their telehealth services to meet the needs of their patients. For more information on how to code encounters related to COVID-19, sign up for our COVID-19 ICD-10 Coding learning series. This series teaches coders how to apply the new 2022 ICD-10 COVID-19 codes. The course also teaches how to code Coronavirus infections, symptoms, screening, post-COVID-19 condition, treatments and vaccines. The webinar provides an update to the FY2022 Official Coding Guidelines for COVID-19.
Additionally, for continuous updates on coding for COVID-19, stay tuned to our YES Blog.
Lastly, learn about Risk Adjustments and HCC Basics from YES Education: Overview of Risk Adjustment and Hierarchical Condition Categories (HCC). Key concepts, Outline HHS and CMS Models, Risk Adjustment. Documentation and Coding Practices, Auditing and Monitoring. 1 AHIMA & AAPC CEU.