When medically relevant, a phone call can offer an effective means of care

We have heard much in the past three months regarding COVID-19 and the expanded need for telehealth services due to social distancing. Time will tell whether our nationwide plunge into telehealth results in permanent changes. I do appreciate, as do my patients, the idea of “paid for” legitimate access to eye health care in multiple ways — let’s just be certain we have our codes in order.

WAIVER FOR AUDIO-ONLY

Let’s make certain to bill, or have billed, appropriately for audio-only telehealth services. As we may remember, in March it was announced that CMS would pay for telephone visits (no video component). However, the reimbursement was extremely low. After feedback, CMS announced on April 30 the payments would increase and would be retroactive to March 1. (You may read the announcement at go.cms.gov/2XS1tOf .)

Specifically, the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, found here go.cms.gov/3dUzdjg , says: “This waiver allows the use of audio-only equipment to furnish services described by the codes for audio-only telephone evaluation and management services, and behavioral health counseling and educational services.”

The list of codes may be found here: go.cms.gov/2B0NNXW . However, those relevant to eye care include 99441, 99442, 99443 for new and established patients; they are being paid at the reimbursement rate of 99212–99214. Let’s make certain if we billed already, we billed appropriate fees and if we have not, to make certain we change the fees to be commensurate with our 99212-99214 codes. Let’s not forget modifier 95 and verify which of our insurance plans require place of service 2.

CODES TO USE

According to CMS.gov : “Telephone E/M service by a physician or other qualified healthcare professional who may report E/M services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment” include:

• 99441: 5 to 10 minutes of medical discussion.
• 99442: 11 to 20 minutes of medical discussion
• 99443: 21 to 30 minutes of medical discussion

Documentation should include:

• Date of service
• Participants in the call and titles
• Length of call
• Nature of call
• All medical decisions made

Be aware insurance companies are all at different stages of implementing these changes. Some will have specific nuances to their coding for telephone-only visits and some will be slower to update their systems to pay us. Check with each of the insurance plans to see how they want these claims sent in and, if denied, call and verify the reason. Most insurance plans will resubmit any incorrectly paid claims if they resulted from their systems not being updated at the time of the submission; however it is always good to verify.

EFFECTIVE FOR PRACTICE AND PATIENT

As we look to the future, let’s remember what we have endured and determine what we need to keep to make the patient experience better. Hand-in-hand with this is to follow the insurance companies’ rules closely to see what they agree will continue to be paid for. When medically relevant, I do believe a phone call can be more cost effective for both the patient and the practice. OM

DR. JASPER practices in West Palm Beach, Fla.. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.