b'1.The patient must initiate the service. If using the time override, these things would need to be 2.The services must be medically necessary. documented in the encounter as well as time. The current time requirements for these E/M codes are as follows:3.These codes can only be reported once per 7-day period.9921210 minutes4.Do not report online digital E/M services for cumulative time lessthan 5 minutes. 9921315 minutes5.Do not report these codes on a day when other Evaluation and9921425 minutesManagement services are performed. 9921540 minutes 6.These services are not for the non-evaluative electronic communi- For an in-office encounter, the face-to-face time must equal atcation of test results, scheduling of appointments, etc. least half of the total time. For telemedicine, it seems that it would While these services must be patient initiated, providers couldrepresent the entire encounter since the provider and patient would send out a notice letting all patients know that these services arebe video conferencing. The online evaluation codes (99421-99423) offered by your practice.might then be reported for encounters that occur later. In addition to the above guidelines, when billing for telehealth, theWhile there are no specific physical medicine CPT codes for tele-place of service code that goes in box 24b on the 1500 claim formhealth services provided by chiropractors or physical therapists and should be 02 to indicate The location where health servicesoccupational therapists, it is possible that some payers might allow and health related services are provided or received, through abilling a therapy code such as 97110 with the 95 modifier and the 02 telecommunication system. Additionally, modifier -95 (Synchronousplace of service code. A provider might watch a patient via Skype and Telehealth Service Rendered Via a Real-Time Interactive Audio andprovide guidance while they perform stretching exercises for fifteen Video Telecommunications System) should also be appended to theminutes. This assumes that the same criteria for medical necessity CPT code.have been satisfied as at a live encounter and the documentation is complete.Medicare has two of their own modifiers, depending on the type ofIf this applies to the services you provide, you might consider telehealth and some private payers may also recognize/require these.reporting them. Though it may seem like it has limited application The options are:in a chiropractic setting, patients could be better served, and the Modifier GQ: Via an asynchronous telecommunications systemprovider may be able to generate additional revenue by following theModifier GT: Via Interactive Audio and Video Telecommunicationsscenario outlined above. Check with private payers and your statesystems board to make sure you can bill for these services via telehealth. The AMA has created a list of what they call telehealth-eligibleFor more information on telehealth, providers can review this Guide codes and unfortunately Chiropractic Manipulative Treatmenton billing for telehealth encounters from the Center for Connected (98940-98943) and other physical medicine codes (from the 97000s)Health Policy to get the comprehensive overview on billing. are not on the list. (See Appendix P of the CPT code book for AMAsMedicare has created a CMS Fact Sheet that describes regulatory full list of telehealth-eligible codes.)flexibilities and other actions CMS has implemented to help The common established office evaluation and management codeshealthcare providers and states respond to and contain COVID-19. (99212-99215) are found in Appendix P and can also be billed viaUnfortunately, the actions did not include expanding Medicare telemedicine. It appears that these might be an option instead of thecoverage to include telehealth services furnished by chiropractors or online evaluation codes (99421-99423) when the service meets thephysical therapists, but stay tuned.criteria for two of the three key components (history, exam, medicalRegardless of the payer or policy, all providers must ensure that when decision making), such as what might be required at the onset of aproviding telehealth services and home care, they are practicing new condition. Or they might be used for a counseling encounterlegally and ethically. Providers must also be aware of state and with a time override. CPT specifically states: When counseling and/ federal practice guidelines and payer agreements. or coordination of care dominates more than 50% or the total timeHopefully, some of the information above will help you and your spent face to face with the patient, time may be the controlling factorpractice continue to serve your patients and provide for your family in determining the level of service.Counseling is defined in the CPTand staff.book as discussion with the patient and/or family concerning one or more of the following areas:David Klein, CPC, CPMA, CHC, an ANJC coding and compliance Diagnostic results, impressions, and/or recommended consultant, is the co-founder of PayDC (www.paydc.com), a diagnostic studies web-based EHR/Practice Management system that focuses on Prognosis documentation, compliance and reimbursement. He is a certifiedRisks and benefits of management options professional coder and auditor through the American AcademyInstructions for management and follow up of Professional Coders (AAPC), and is certified in healthcare compliance through the Health Care Compliance Board (HCCB). Importance of compliance with chosen management options He is the founder and president of DK Coding & Compliance, Inc. aRisk factor reduction healthcare consulting firm that focuses on audit defense, education,compliance and reimbursement issues.Patient and family education www.njchiropractors.com I 11'