The best Telemedicine Technology available today will give doctors the online and mobile solutions they need to take care of their patients in a variety of ways.
The good news is that many patients are open to using telemedicine services as a way to get access to medical care directly from their homes or offices. In the hospital environment, the issue becomes more complicated as many doctors may be involved in the follow-up inpatient monitoring.
The challenge is whether specific types of follow-up inpatient visits can be reimbursed under Medicare, Medicaid or by Private Insurance providers.
Currently, the best approach is to follow the guidelines setup by CMS in their Medicare Claims Processing Manual. According to the CMS definition of Follow-up Inpatient:
‘Follow-up inpatient Telemedicine consultations are furnished to beneficiaries in hospitals or
Skilled Nursing Facility via Telemedicine to follow up on an initial consultation, or subsequent consultative visits requested by the attending physician. The initial inpatient consultation may have been provided in-person or via Telemedicine.’
What do Follow-up Inpatient Telemedicine consultations include?
– monitoring progress,
– recommending management modifications, or
– advising on a new plan of care in response to changes in the patient’s status or no changes on the consulted health issue.
Counseling and coordination of care with other providers or agencies is included as well, consistent with the nature of the problem and the patient’s needs.
It is important to note that the follow up cannot be performed by the patient’s physician of record, but rather by an attending physician. According to the CMS:
‘The physician or practitioner who furnishes the inpatient follow-up consultation via Telemedicine cannot be the physician of record or the attending physician, and the follow-up inpatient consultation would be distinct from the follow-up care provided by the physician of record or the attending physician.’
Understanding Pre-Service, Intra-service and Post Service Telemedicine Guidelines
Payment for follow-up inpatient Telemedicine consultations includes all consultation related services furnished before, during, and after communicating with the patient via Telemedicine.
Pre-service activities would include:
– reviewing patient data (for example, diagnostic and imaging studies, interim labwork) and
– communicating with other professionals or family members.
Intra-service activities must include at least two of the three key elements described below for each procedure code.
Post-service activities would include:
– completing medical records or other documentation
– communicating results of the consultation
– further care plans to other health care professionals.
It is also important to note that additional evaluation and management service could be billed for work related to a follow-up inpatient Telemedicine consultation.
What are the reimbursement billing codes for Follow-Up Inpatient Telemedicine?
Follow-up inpatient Telemedicine consultations could be provided at various levels of complexity:
• Practitioners taking a problem focused interval history, conducting a problem focused examination, and engaging in medical decision making that is straightforward or of low complexity, would bill a limited service, using HCPCS code G0406 (Follow-up inpatient Telemedicine consultation, limited, physicians typically spend 15 minutes communicating with the patient via Telemedicine).
• Practitioners taking an expanded focused interval history, conducting an expanded problem focused examination, and engaging in medical decision making that is of moderate complexity, would bill an intermediate service using HCPCS code G0407(Follow-up inpatient Telemedicine consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via Telemedicine).
• Practitioners taking a detailed interval history, conducting a detailed examination, and engaging in medical decision making that is of high complexity, would bill a complex service, using HCPCS code G0408 (Follow-up inpatient Telemedicine consultation, complex, physicians typically spend 35 minutes or more communicating with the patient via Telemedicine).
Although follow-up inpatient Telemedicine consultations are specific to Telemedicine, these services must be billed with either the -GT or -GQ modifier to identify the Telemedicine technology used to provide the service.
