How to Overcome These Common Challenges in Telehealth Coding & Billing

Last Updated June 17, 2024

How to Overcome These Common Challenges in Telehealth Coding & Billing

Since CMS expanded the Medicare payment protocol to include telehealth services during the COVID-19 public health emergency, healthcare providers have experienced challenges in telehealth coding and billing (CMS, 2020). Knowing how to accurately code and bill telemedicine services has been one of the biggest telehealth problems that practices are running into. This is due to the amount of policy changes released over a short time period, as well as the lack of experience in documenting these services.

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Here are the other most common challenges in telehealth and most popular questions about telemedicine:

Challenge 1: What are the codes to bill for telehealth services?

Solution 1: CMS has designated these are the correct codes to use for billing telehealth services: G2010 – Evaluation of patient images or video (not originating from or leading to an E/M service) (AASM, 2020); G2012 – Virtual check-in or another technology-based communication with a healthcare provider (CMS, 2020); G2061-G2063 – Online assessment and management service provided by a qualified non-physician healthcare professional; 99421-99423 – An online evaluation and management service provided to an established patient for up to 7 days; and 99441-99443 – Telehealth services provided only via telephone. Healthcare providers should enlist the help of an independent auditing vendor. They can conduct focused or periodic audits to monitor their team’s documentation, as well as ensuring they are accurate and compliant with the revised Medicare telehealth guidelines.

Challenge 2: How do I select the right POS and modifier?

Solution 2: According to the CMS interim final rule, during the PHE, coders will not use POS 02 telehealth. Instead, coders who are using the CMS-1500 form should use the POS that would have been used if there was no PHE in place (2020). For instance, coders should use POS 11 if the provider would have seen the beneficiary in a clinic. The appropriate modifiers to amend telehealth billing claims are:

95 – telehealth service provided via audio and video technology;

G0 – telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke;

GT – telemedicine services provided by interactive audio/video telecommunication systems (Critical Access Hospital (CAH) Method II only); and

GQ – telemedicine services provided via asynchronous telecommunications system (Alaska & Hawaii demonstration project only). Click here for an in-depth explanation of all the policy and regulatory revisions on POS and modifiers. For additional guidance, providers should find an external coding support vendor. They can provide further assistance with selecting the right POS and modifiers.

Challenge 3: How should coders document telehealth visits for accurate reimbursements?

Solution 3: Accurate, complete documentation of telehealth services is key to receiving the correct payment. Selecting the right codes for telehealth services depends on the type of audio or visual communication tool used during the visit, as well as the provider’s findings and treatments. Face-to-face patient visits via video communications must include the date and platform used to provide the service. Label patient visits done by audio-only, phone calls, or over email correspondence, as non-face-to-face encounters. They also need to include date and whether it was an audio-only communication or conducted through a patient portal. Healthcare providers can boost their coding team’s efficiency and accuracy by enrolling them in continued coding education. They can become more familiar with these revised telehealth expansions and dispel further questions about telehealth.

Review the articles in our Telehealth Resource Center below for more information.