If you do Televisit and the patient ends up coming to the office the next day with the same chief complaint, do one of the visit charges gets invalid and not paid for?
In this specific scenario, you would not bill the TM visit- just the in-person visit. The TM vist can only be billed is not related to any condition seen in the past 7 days or subsequent 24 hours…
But if they had a new chief complaint, then is both billable? And is it 24 hours or calendar day from the TeleVisit that you can’t bill? I was not even aware that if it was within 7 days then its not billable. Do you have any resources where I can forward to my business manager reviewing these particular situations.
Thank you so much for your response. Your webinar and this website has been super helpful during this time.
Because lots of these terms are synonymous depending on the context, I find it helpful to keep this straight by way of codes used. This content comes straight out of CPT.
Depending on how you’re meaning Televisit:
-If you bill a 9921X-95 for using real-time video, there’s no 7 day requirement irrespective of the chief complaint. It’s just as if the patient came to your office two days in a row.
-If you bill phone care, the guidance for 99441-99443 states “If the telephone service ends with a decision to see the patient within 24 hours or next available urgent visit appointment, the code is not reported.” I see nothing which prohibits billing for both phone care and then a face-to-face visit with 7 days. How flexible your carriers are about interpreting that “phone call ends with a decision to see the patient” circumstance will be paramount here. If for unrelated chief complaint, I don’t see how the call could have ended with a decision to see the patient for something new, so you could bill both.
-If you bill online digital care, the guidance for 99421-99423 states that for any E/M service within seven days, “… the work devoted to the online digital E/M service is incorporated into the separately reported E/M visit (eg, additive of visit time for a time- based E/M visit or additive of decision-making complexity for a key component-based E/M visit.” The language here does not allow for handling unrelated complaints different to continuation of care for the originating complaint. It appears as though the online visit would be incorporated into the office location visit and is not separately billable.
I thought this was the guidance for phone visits but NOT telehealth audiovisual visits.
I am no billing expert but that is not been true for the many I talk with… same day not billable… next day it is billable… I would check on local rules with carriers as I think this 7 day rule has largely gone away.
HI Paulie, i think the 7 day rule applies only to phone visits, not telemedicine. I think telemedicine visits are counted just like any other in-person visit. Can you confirm this? Thanks!
I think you’re right. I don’t see anything in CPT guidance to suggest that 9920X or 9921X has the 7 day restriction that the telephone and online/digital codes do.