March 17, 2020

In our effort to continue to provide the latest news during the COVID-19 pandemic we would like to update you regularly with important and useful information. Please see the latest updated information below from MedChi. We have also included a resource from the American Academy of Ophthalmology regarding coding telephone calls. Thirdly, please see the information about expanded telehealth regulations from Corcoran Consulting Group. MSEPS does not endorse the Corcoran Consulting Group sponsored linked websites or events, and we do not endorse the views they express or the products/services they offer.  

Renee Bovelle, MD
MSEPS President
Dear MedChi Members,
I wanted to share the latest information and resources for addressing the growing COVID-19 pandemic in Maryland. Please know that MedChi is here to support you through this.
  • The Maryland Department of Health has granted permission at MedChi's request for all physicians to participate in Dr. Howard Haft's update call on Wednesday, March 18, 5:00pm-5:30pm. Register here.
  • MedChi is working closely with DrFirst to help physicians access their Backline telemedicine platform. DrFirst is providing 30-day access at no charge for Maryland physicians; the platform is $300 per user after that.
  • Together with the Maryland Nurses Association and Rockpointe, MedChi is hosting a live CME webinar for clinicians in outpatient offices on Friday, March 20 at 1:00pm. The focus will be on handling symptomatic patients in ambulatory care settings. This content will also be available online after the event.
Thank you for your membership; your support allows us to provide the services and resources that are critical in this time of uncertainty. And above all, thank you for all that you do as physicians and healers.
Gene Ransom
MedChi CEO
Coding for Phone Calls, Internet Consultations and Telehealth

Note: Carriers update their policies frequently. Check for updated information.

There are three options for telehealth and other communications-based technology services. This information is based on guidelines from the Centers for Medicare & Medicaid Services.

Over the past few days, CMS and HHS have allowed for the expanded use of Telehealth services during the COVID-19 public health emergency. CMS Administrator Seema Verma, in public remarks also posted on the CMS News Feed, noted that CMS would allow “people to communicate with their providers from home and limit the spread of the virus.” This option for services applies whether patients have suspected symptoms of COVID-19 or not – it helps us keep non-emergent patients and the general public safe.
There are a number of ways to deliver telehealth. In this situation where patients may be limiting their travel to physician offices except for emergencies or urgent care, most providers will use (1) phone-only or (2) simultaneous phone/video.
(1) For telephone calls with established-status Medicare Part B patients that are not for technician or medical assistant calls, or were not already paid for (post-op checks in a global period, for example), HCPCS Code G2012 may be appropriate. CMS notes that this code is for 5-10 minutes of provider time. You may have heard this described as a “Virtual Visit” code. Other particulars about the use of this code and the required documentation are:
  • Note the patient’s consent to this type of visit.
  • Document the discussion topic to include the medical necessity (e.g., history, action).
  • As noted above, document that this conversation took place with the provider, what time the call began, and its length (at least 5 minutes).
  • Other restrictions related to billing G2012 are as follows:
·         The call was not related to an office visit that took place within the past 7 days.
·         An office visit related to the call is not anticipated in the next 24 hours (or “next available” appointment).
·         Private payers and Part C Medicare plans may vary on coverage and payment.
  • National 2020 payment under Medicare Part B for G2012 is $14.81.
(2) If the visit includes simultaneous video and phone, and the patient is a Part B beneficiary, it is possible to use our familiar outpatient Evaluation and Management (E/M) codes ( 99201-99205 and 99212-99215 ). Importantly, without the possibility of a live fundus exam, IOP, gross visual fields, or motility, the level of service is limited. It is likely that only CPT code 99202 for new patients and 99212 or 99213 (established patients) are possible. Claims should be submitted with the POS as “home” (12) since that is where the patient is, and be sure to use the telemedicine modifier 95 for synchronous telemedicine service. Use the current E/M rules to determine the level of service. Note: eye exam codes (920xx) are not designated with a star (*) in CPT as Telehealth services so that coding option is not currently available. 
There are a few new codes in 2020 for “Internet” or online evaluations of established patients. They are not for use when the patient has “new patient status”. The physician codes are as follows:
  • 99421 Online digital evaluation and management service, for an established patient, for up to 7 days; 5-10 minutes
  • 99422 11-20 minutes
  • 99423 21 or more minutes
  • CPT notes these restrictions on 99421/2/3:
  • These are patient-initiated services through secure platform (such as your patient portal) where there is a secure, electronic evaluation/assessment/management of the patient by the provider
  • If staff other than a provider does this, it is not a billable service.
  • These 3 codes are not to be used if:
·         Electronic communication of services takes place but the total is less than 5 minutes,
·         Solely for the communication of diagnostic test results,
·         Appointment scheduling,
·         Post-op checks, or
·         Other “non-E/M” services.
  • Cumulative and related “e-time” for the provider is tracked over 7 consecutive days and tallied up - then only ONE code for the total time is billed.
  • If there is an online service unrelated to an office visit on the same day or within 7 days it may be separately reported (see above for 99212, 99213, 99202).
  • If a related billable (e.g., office-based) E/M exam service happens on the same day or within 7 days, this online service is not billed.

Payment under Medicare Part B (national) is as follows:
  • 99421: $15.52
  • 99422: $31.04
  • 99423: $50.16
We are also asked about using the “phone call codes” in the 2020 CPT book. These are codes 99441 – 99443 for physicians and 98966 – 98968 for NPs and PAs. None of these codes are covered for Part B Medicare in 2020; check with other payers as they may vary.
We are happy to assist you with claims issues and other topics related to eye care during this public health emergency. You can download our “App”, Corcoran 24/7 via one of the links below. (800) 399-6565
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Disclaimer: MSEPS does not endorse the organizations sponsoring linked websites or events, and we do not endorse the views they express or the products/services they offer.  
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