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Question 1

If phone communication with a patient was less than 5 minutes, can we still bill 99441?

Answer

No, 5 minutes will be the minimum time required for 99441, which describes Telephone evaluation and management service of 5-10 minutes of medical discussion. The same minimum time requirement applies to G2012 - Brief communication technology-based service.


Question 2

If a Medicare patient does not have Skype or another audio-video app, and Doctor spends more than 10 minutes on the call with the patient, can we bill a regular E&M service?

Answer

Regular E&M services, e.g., 99201-99215, cannot be billed to Medicare when the audio-only system was used to perform the service. Interactive audio and video telecommunication system that permits real-time communication must be used for the services to be qualified as delivered via Telehealth.

However, besides a wide range of Communication Technology-Based Services (Virtual Check-In, E-Visits) Medicare now covers telephone E&M services for new and established patients (as per CMS-1744 IFC). 
CPT codes 98966-98968 (for LCSWs, clinical psychologists, and physical therapists, occupational therapists, and speech-language pathologists when the visit pertains to a service that falls within the benefit category of those practitioners) and 99441-99443 (for Physicians and practitioners who can independently bill for E/M services).

99441 - Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
99442 – …... 11-20 minutes of medical discussion
99443 – …... 21-30 minutes of medical discussion

98966 - Telephone assessment and management service provided by a qualified non-physician health care professional to an established patient, parent, or guardian
not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
98967 - …... 11-20 minutes of medical discussion
98968 - …... 21-30 minutes of medical discussion
Services must be properly documented. Patient consent is required. Cost-sharing will apply.

Question 3

The provider received multiple calls from a patient during the day. How to properly code and bill Medicare for the multiple telephone communications with the same patient during a day?

Answer

Proper coding and billing will depend on numerous factors, such as the nature of care, problems evaluated, and the total time spent rather than the number of calls.

For Example, if the phone conversations were related to the patient-initiated online evaluation and management services (99421-99423, G2061-G2063), then the appropriate code will be chosen based on cumulative time spent during seven days period.
The online digital evaluation and management service includes time spent on the following:
• Review of an initial patient’s inquiry (start of the 7-day period)
• Review of patient record for assessment of the patient’s problem
• Interaction with other healthcare professionals focused on the patient’s problem
• Development of management plans (prescriptions, test orders, etc.)
• Communication with the patient (online, email, etc.)
If the patient contacts the provider about a problem addressed in the E&M service that occurred during the 7-day window, the work would be included in the face-to-face E&M service performed during that window.

If the services represent virtual check-in (G2012) or Telephone E&M (99441-99443, 98966-98968), make sure that those services are not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

Question 4

Considering the latest updates, are the Physical therapists, Occupational therapists, Speech-Language pathologists eligible to perform and get paid for telehealth services furnished to Medicare beneficiaries?

Answer

No. Although, on an interim basis, the PT/OT/Speech therapy services were added, to the list of services that can be performed via telehealth, the physical therapists, occupational therapists, or speech-language pathologists were not added to the list of eligible distant site provider types.
According to the CMS-1744 IFC “The statutory definition of distant site practitioners under section 1834(m) of the Act does not include physical therapists, occupational therapists, or speech-language pathologists, meaning that it does not provide for payment for these services as Medicare telehealth services when furnished by physical therapists, occupational therapists, or speech-language pathologists.”


Question 5

Jennifer, 

We're mostly closed.  I have a few scheduled post-op and emergency visits scheduled for tomorrow.  I anticipate more of the same next week, perhaps going in 1-2 days next week.  What am I supposed to do for my staff - I have 8 employees.  

Any advice is appreciated. 


Dr. P


Answer provided by Jennifer Kirschenbaum, Esq., on 03/27/2020:

Everyone's situation is just a bit different.  The employees have different arrangements - some have contracts, some are at will, some are 1099s, some have annualized PTO, some have accrual, some have no PTO.  Some have had COVID-19 already, and some are on leave now.  Some have children home from school and may seek to go out on benefit.  
We need to speak so I know your specific circumstances for me to properly advise. 
That being said, here are some of what is required and available to Employers to date, with the DISCLAIMER that the federal stimulus, phase 3, the CARES Act, is not law yet, and is certainly subject to language changes, and the below is provided in summary form (for simplicity sake) and subject to qualifications and modification -  

  • NYS requires 5 days of PTO to COVID afflicted employees (quarantine or isolated)
  • As of April 2nd - Federal Law will require anyone with more than 10 employees and Net Income of more than $1mil, to pay at least 80 hours of PTO to COVID afflicted employees (quarantine or isolated), and 80 hours at 2/3 pay if an employee is caring for someone else
  • As of April 2nd - Federal Law will require any employer with more than 10 employees and Net Income of more than $1mil to pay not more than $200 per day for any employee out caring for a child (anyone under 18) for up to 12 weeks
  • CARES Act has a construct for an overhead replacement Loan construct, with the amounts used for employee salary (paying employees up to an annualized salary of $100,000 for a period of 4 months - so capped at $33,333 per employee) to be forgivable, interest deferred for at least 6 months, interest capped at 4%, and no prepayment penalty.  Each individual business can get an amount equal to its overhead, capped at $10mil  (APPROVAL, AVAILABILITY AND DETAILS PENDING)
  1. Includes language that employers can rehire anyone previously fired during COVID-19 Pandemic and qualify
  2. Email Stacy Spector, Esq. (sspector@kirschenbaumesq.comto schedule a consultation regarding COVID-19 CARES Act Loan Qualification (final details will be available next week, but we can schedule a time to discuss)
  • CARES Act supplements Unemployment Insurance by adding $600 per week to the State benefit for each employee on Unemployment.  The State will administer this program and send the extra $600 out per week employees on unemployment.
What the above summary details are the vehicles available and considerations an employer must take into account when deciding the path forward.  We know you may need staff during this time for scheduling, billing, assistant services, etc., and such need may be on a part-time basis.  The decisions for one practice do not necessarily fit another.  If you are seeing emergency visits now, please spend time asap solidifying your sterilization protocols.  The first place to look is the CDC recommended protocol, and also please consult your specialty society.  
To set your plan for your practice, please email Kathleen (klampert@kirschenbaumesq.com)  to set a consult time.  

COVID-19 Resources 

CLICK here for K&K's COVID-19 Legal Resource Center 
Available K&K Webinars on COVID-19 Related Legal Issues - 

  • Ophthalmology Specific - Essential Services, State v. Federal PTO, Preview of CARES Act (Forgivable Loan Program, etc), Terminating Employees and Panel discussion - https://youtu.be/Bda9qvddlaE 
  • Dental Specific - Essential Services, State v. Federal PTO Requirements, Business Misc., Terminating Employees, FAQ - https://youtu.be/CB3z3j9Z-9E
Insights
March 2020