Telemedicine Services Coding White Paper-Telemedicine Service Coding

Telemedicine Service Coding

Pdf Summary

Telemedicine is the provision of healthcare services through communications technology. It can range from a phone conversation with a primary care provider to an interactive video conference. There are three main categories of telemedicine: store and forward, real-time interactive, and remote patient monitoring. Store and forward involves collecting patient health information and forwarding it to a specialist for diagnosis. Real-time interactive telemedicine allows for a real-time interaction between a healthcare professional and a patient using audio and video technology. Remote patient monitoring involves capturing health information from a patient and transmitting it to a healthcare provider for management of medical conditions.<br /><br />The reporting of telemedicine services varies by payor and is dependent on state regulations. The American Telemedicine Association provides a commonly used definition of telemedicine. In 2017, Current Procedural Terminology (CPT) published a new modifier and appendix related to telemedicine services. Telemedicine services are denoted with a star symbol and a place of service code 02 for telehealth.<br /><br />Telemedicine services can include healthcare visits, consultations, diagnostic services, disease and chronic condition management, and remote primary or specialty healthcare coverage. There are also emerging services such as mobile healthcare delivery through smartphone applications and electronic messaging between patients and providers.<br /><br />When billing for telemedicine services, the hosting facility should use the appropriate service code and modifier, and the performing provider should submit the claim using the appropriate code and modifier. Medicare has specific reimbursement guidelines for telemedicine services, including a facility fee for the originating site and reimbursement for professional services.<br /><br />Telemedicine arrangements must comply with legal and regulatory requirements, including fair market value compensation under the Stark Law and Anti-Kickback Statutes. The valuation of telemedicine services takes into account factors such as availability, burden, and likelihood of reimbursement.<br /><br />Overall, telemedicine has emerged as a cost-saving solution for healthcare delivery, particularly in rural areas with limited access to providers. Reimbursement for telemedicine services varies by payor, and regulatory compliance issues should be considered when implementing telemedicine programs.

Keywords

telemedicine

healthcare services

communications technology

store and forward

real-time interactive

remote patient monitoring

reimbursement guidelines

facility fee

legal requirements

cost-saving solution