All the relevant codes in one place.

Introduction

    If you want to know to the answer on how you can get reimbursed for remote care in 2019, click here to skip to the relevant section. But I recommend you read the intro, as it builds the context for all the change that is happening. Whatever industry you set your eyes on, there is a move towards personalization and independence of the customer. Cinema is on the decline, streaming giants like Netflix are partnering with entertainers to bring you high quality content that you can watch on any screen inside your home. Major grocery retailers like Walmart and Costco have delivery options so you can choose the items that you want delivered to your house. Healthcare consumerism is taking a similar path, where the patient wants to receive care, but at their own pace and leisure. Additionally, it is more cost effective on the long run, and thus both private payers and CMS (Center for Medicare & Medicaid Services) are interested in implementing it. The United States government has taken notice accordingly. CMS released its final ruling on the Medicare Physician Fee Schedule (PFS) at the end of last year. We went through the document to highlight the codes that you can use to be reimbursed for providing remote care services.

    Both Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are used to record healthcare services and their associated payments. CPT came first and is the de facto communication standard among physicians, coders and just about all stakeholders who are concerned with payments. It is maintained by the American Medical Association (AMA). HCPCS came after CPT and is based on the latter. It standardizes the coding established by CPT to help understand what type of healthcare services are being offered. It contains three levels of codes, of which level one consists of CPT codes. Unlike CPT, it makes its information publicly available, which is why it is possible to research the changes in the codes.

    One important distinction to make here is that these are all codes, not laws. While certain healthcare laws like SUPPORT Act have facilitated the remote treatment of substance abuse disorder patients, they did not impact any codes which providers can use to bill for related services. Similarly, the Bipartisan Budget Act of 2018 have made remotely treating end stage renal disease (ESRD) and acute stroke much easier, by lifting certain geographic requirements which bars reimbursements for telehealth. But again, no new code in the books have been enacted to officially open new streams of revenue, only that accessing and treating the patients have been made easier. Such laws are extremely important for further pushing the advent of telehealth, and the SUPPORT Act was featured in our list of 50 reasons explaining telehealth’s rise in the USA. But this list explicitly
focuses on the codes.

CPT Codes

Code Subsection: Digitally Stored Data Services/Remote Physiologic Monitoring

CPT code 99453: “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; setup and patient education on use of equipment.”

CPT code 99454: “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”

Code Subsection: Remote Physiologic Monitoring Treatment Management Services

CPT code 99457: “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”

What it implies: The process of onboarding a patient into remote care is split up into parts, which serve as multiple billable touchpoints. From initial setup and education, to 30-day monitoring of the physiologic measures, to the management of the service by physicians or staff. Staff is an added inclusion for 2019, which was not there in the code for 2018. It’s interesting how remote care is deemed important enough to warrant two subsections by itself. Indeed, it is not necessarily restricted under the umbrella of telemedicine, but rather looked at as a separate field.

Code Subsection: Interprofessional Telephone/Internet/Electronic Health Record Consultations

CPT code 99451 – “Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician including a written report to the patient’s treating/requesting physician or other qualified health care professional; 5 minutes or more of medical consultative time “

CPT code 99452 – “Interprofessional telephone/Internet/electronic
health record referral service(s) provided by a treating/requesting physician
or other qualified health care professional, 30 minutes.”

What it implies:  Healthcare is a profession in which there are several degrees of specializations. Thus, when dealing with specific situations, consultations with specialists are a very common occurrence. The new CPT codes recognizes the role that telehealth plays in first enacting such a consultative approach, and then executing it. As technology was always used anyway to ask for consultations, it only makes sense to officially constitute the act as a code, but also include the actual e-consultation as a part of the services.

Code Subsection: Chronic Care Management Services

CPT Code 99491- “Chronic care management services provided personally
by a physician or other qualified health care professional, at least 30 minutes
of physician or other qualified health care professional time, per calendar
month, with the following required elements:

• Multiple (two or more) chronic conditions expected to last at least
12 months, or until the death of the patient;

• Chronic conditions place the patient at significant risk of death,
acute exacerbation/decompensation, or functional decline;

• Comprehensive care plan established, implemented, revised, or
monitored”

What it implies: Adding new codes for Chronic Care Management only signifies the need to manage it as the population ages further. There is recognition of its ongoing nature, as care is expected to be delivered and billed for at least a year. Also, the third subpoint connects chronic care to remote care, as the latter is a massive aspect of the former. Without monitoring, chronic care management falls short of its expectations
where  tracking a patient’s health status is paramount.

HPCS Codes

HPCS Code G2012 – “Brief communication technology based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion”

HCPCS code G2010 – “Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with verbal follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.”

What it implies: These two codes have the power to possibly make telehealth services mainstream if they are used widely by healthcare practitioners. This is because they cover two of the three major faces of telemedicine, i.e., virtual visits and Store-and-forward technology where pre-recorded images or videos are sent to the doctors to be evaluated. If you are wondering, the other major expression of telemedicine is remote patient monitoring which the CPT codes already cover. There are provisos in place to ensure that there are no unnecessary overcharges by having an actual visit take place too close to a remote visit or consultation. But the fact that these two services are now billable relays CMS’s confidence on them being able to exist as standalone services. There have been enough cases where they have prevented unnecessary hospital visits to mandate their necessity as a value adding service.

Wrap-up

  There have been multiple studies out that show the lack of patient awareness of telehealth services offered by their providers. But perhaps, it’s also an issue of the providers not being able to market the billable services adequately, as the final ruling law changes went into effect in the beginning of this year. There is a noticeable lag in the market. We hope this post can expedite the end of that lag as changes are coming in thick and fast. In future, as healthcare models become integrated, more changes will be implemented that favor remote care. The idea is to deliver value-based care to a patient no matter where that patient is located. But as more CPT and HCPCS codes are added or modified, they need to be used in practice. You do not want to end up with a situation where you suddenly have to play catch up. Only with use of these codes, can you prevent yourself against coding errors such as upcoding or unbundling. Also, by not taking advantage of these codes, you might be disqualifying yourself from certain pay for performance programs. In short, be aware of all your remote care reimbursement options, and use them to become more efficient at offering those services. Many changes have been proposed for 2020 and even 2021 already. But it first starts with integrating what’s already on the table.

I hope you got value out of this article on the options available to providers to get reimbursed for remote care. Are there any other codes I missed out on? Email me at rahat.haque@aetonixsystems.com. Or let us know on our media channels.

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We are Aetonix. We simplify complex healthcare. Full disclosure, we are in Telehealth. But we are involved in Remote Patient Monitoring for those who needed it most, patients suffering from complex needs.  

References

https://www.govinfo.gov/content/pkg/FR-2018-11-23/pdf/2018-24170.pdf