For a majority of ODs, 99 codes work best
Orlando, FL—Telehealth expanded rapidly for many ODs after the start of the pandemic. According to the Centers for Disease Control (CDC), the number of telehealth visits increased by 50% during the first quarter of 2020, compared with the same period in 2019.1 This led to a marked shift in practice patterns that still affect ODs. Christopher Wolfe, OD, FAAO, Dipl ABO, discussed best practices of telehealth implementation during a lecture at Vision Expo East 2021.
What ODs can do right now
“I don’t think there is going to be a reversal on implementing telehealth services,” Wolfe says. “If anything, I think there will be ongoing payments and expansion from here on out.”
The first thing ODs should do when implementing telehealth services is consider all the clinical situations that can be used. Things like contact lens checks, eyelid checks, and conjunctivitis screenings are good places to start. Next, make sure medical insurance carriers cover all services. Coverage information can usually be found online or call carriers to ask, Wolfe suggests.
With assurance that services are covered, it is time to move patients to a new telehealth system.
Several free applications are available to make implementing telehealth easy. Doxy.me, Zoom, and Facetime allow for simultaneous, back-and-forth communication with video and audio, so all will work. However, Wolfe suggests ODs use doxy.me over Zoom and Facetime because of its simplicity and ease of use.
Says Wolfe: “The reason I like doxy.me, in addition to being simple, is that if a patient texts me or calls me and I immediately take the call, I can very quickly say, ‘Hey, this sounds like something that I want to be able to see face to face. Let's jump on. Here is the link.’ Boom. I can send him a link that takes him directly to the portal. I log in, he logs in. It is that easy.”
The majority of services ODs provide can be appropriately coded with 99 codes, Wolfe says. Follow documentation guidelines and consider the following:
· Don’t use 920XX codes
· Don’t get bogged down with other codes if you are just starting out
· When billed, use 11 (Medicare) or 02, depending on payer
· Use -95 modifier on your 99-code to identify telehealth services
“I recommend using 99 codes most frequently because they have a longer time limit, and they are the most clearly defined. If I saw a patient yesterday in my practice and I want to see him today, online, remotely, I can do that. All I have to do is satisfy medical necessity and any 99-specific code requirement.”
When it comes to modifiers, check with your carrier before billing.
“Most carriers want a 95 modifier on your 99 codes, some Medicaids will want GT modifiers, but most of them now have consolidated to match content management system,” says Wolfe.
Virtual check ins are short meetings that occur via video, telephone, or other telecommunications to decide whether an office visit or other services are needed. Wolfe says to use these rarely because nuances make them more challenging to code.
One nuance related to virtual check-ins is that the service must not originate from a related service provided within the previous 7 days, nor leading to a service or procedure within the next 24 hours or soonest available appointment.2 A virtual check-in must also include 5 to 10 minutes of medical discussion.2
“If captured images or video files are sent to the patient, you would also need to build a G-2010 form,” Wolfe says.
An e-visit is a communication with an established patient through an online portal. Wolfe says to use these sparingly and only with a non-face-to-face patient-initiated communication. Codes for e-visits are:
· 99421 if 5 to 10 minute visit
· 99422 if 11 to 20 minute visit
· 99423 if 21 minutes or longer visit
A telehealth service visit occurs when a patient uses real-time audio and video telecommunication systems to meet with a provider. Wolfe recommends using these most frequently because they are reimbursed at the same rate as in-person visits and are all ODs need to quickly and easily provide care.
Codes for telehealth services are 99201 to 99215. They do not include 92-codes. Additionally, they have -95 modifiers. When signifying a place of service, use 11 for office and 02 for telehealth.
1. Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic — United States, January–March 2020. MMWR Morb Mortal Wkly Rep.2020;69:1595-1599. doi: 10.15585/mmwr.mm6943a3external icon
2. Medicare’s virtual check-in codes. American Optometric Association. Published July 31, 2019. Accessed June 17, 2021. https://www.aoa.org/news/practice-management/billing-and-coding/medicares-virtual-check-in-codes?sso=y