Resolved E/M Code 99214

[LisaH_40390]

With the new AMA changes Jan. 1, 2021 can we use the code 99214 for medication management via telepsych. or is this only if the have a new problem or prescribed new medications?

 

[Darcy]

telepsych? Do you mean a phone call?

 

[LisaH_40390]

telepsych? Do you mean a phone call?

Yes

 

[Darcy]

Medicare’s Three Main Types of Telehealth Services

Type of Service

What is the Service?

Code(s)

Patient Relationship with Provider​

Medicare Telehealth Visits

A patient visit with a Medicare provider using (in most cases) a live (audiovisual) telecommunications system to deliver the healthcare service.

For 2020, there are 100 services Medicare lists as covered when rendered via telehealth. Some common telehealth services include:

• 99201-99215 (Office or other outpatient visits)​
• G0425-G0427 (Telehealth consultations, emergency department or initial inpatient)​
• G0406-G0408 (Follow-up inpatient telehealth consultations in hospital or SNF)​

See an innoviHealth Reimbursement Guide for a complete listing.

New* or established patient

* Technically these codes are ONLY for an established patient. However, during this crisis, HHS stated that they will not conduct audits to check if this is an established patient so you can use them for a new patient.

Virtual Check-in

A brief (5-10 minutes) check in with a patient via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

• G2012​
• G2010​

Established patient

E-Visits

A communication between patient and their provider through an online patient portal which is initiated only by the patient.

Note: Providers cannot initiate the service but they CAN inform patients this service is available.

• 99421-99423​
• G2061-G2063​

 

[LisaH_40390]

Medicare’s Three Main Types of Telehealth Services

Type of Service

What is the Service?

Code(s)

Patient Relationship with Provider​

Medicare Telehealth Visits

A patient visit with a Medicare provider using (in most cases) a live (audiovisual) telecommunications system to deliver the healthcare service.

For 2020, there are 100 services Medicare lists as covered when rendered via telehealth. Some common telehealth services include:

• 
  99201-99215 (Office or other outpatient visits)​
  
  
• 
  G0425-G0427 (Telehealth consultations, emergency department or initial inpatient)​
  
  
• 
  G0406-G0408 (Follow-up inpatient telehealth consultations in hospital or SNF)​

See an innoviHealth Reimbursement Guide for a complete listing.

New* or established patient

* Technically these codes are ONLY for an established patient. However, during this crisis, HHS stated that they will not conduct audits to check if this is an established patient so you can use them for a new patient.

Virtual Check-in

A brief (5-10 minutes) check in with a patient via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

• 
  G2012​
  
  
• 
  G2010​

Established patient

E-Visits

A communication between patient and their provider through an online patient portal which is initiated only by the patient.

Note: Providers cannot initiate the service but they CAN inform patients this service is available.

• 
  99421-99423​
  
  
• 
  G2061-G2063​

Thank you
I just want to make sure if we bill 99214 instead 99213 for telehealth medication management that it requires a new problem or a medication change for establish patient correct even if its a 15 mins increment? I'm just trying to make sure we will be safe if we bill the 99214 for refill medication management on client. Not all of them are medicare clients. Sorry i maybe a little confusing in explaining it.

 

[Darcy]

Moderate (99204/99214)

Moderate 1> chronic w/exacerbation,, progression, side effects of treatment OR 2> stable chronic OR 1 undiagnosed new problem w/uncertain prognosis OR 1 acute illness w/systemic symptoms OR 1 acute uncomplicated injury

Moderate (must meet at least 1 of 3 categories): Category 1: Tests/documents or independent historian (any combination of 3): Review prior external note(s) each unique source Review of results of each unique test Ordering of each unique test Assess req independent historian OR Category 2: Independent Interpretation of Tests Independent Interpret test performed by another MD/QHCP (not separately reported) OR Category 3: Discussion management or test interpretation Discussion of management/test interpretation w/external MD or QHCP/appropriate source (not separately reported)

Moderate risk morbidity from additional testing or treatment Examples: Prescription drug management Decision minor surg w/identified patient or procedure risk factors Decision elective major surg w/o identified patient or procedure risk Dx/treatment significant limited by social determinants of health

 

[LisaH_40390]

Ok this part is what I was wondering about...
Moderate risk morbidity from additional testing or treatment
Examples:
Prescription drug management

Thank you for your help.