Telehealth visits?

[AdmiralChz]

Given the ongoing pandemic we are trying to avoid having people come to the hospital. I’m a medium private practice and do preop consults as requested (mostly high risk/complex OB but a few other things). We usually have them come in and a partner sees them on the fly. Not a great setup.

Now we have an opportunity to change things up. CMS has relaxed a lot of the TeleHealth rules (can be done from home, patient doesn’t have to live in a critical access area) and I was wondering if any docs out there are doing Telehealth visits. What I have found on the ASA and CMS websites are to bill as a 60 minute critical care consult (G0508 CPT code). I have reservations about doing that routinely but honestly the coordination for the high risk / cardiac OB cases merits a critical care review and I frequently spend that much time in review/patient discussion/interdisciplinary conversations.

The idea is to get potentially some reimbursement above zero which is what we have did before. Anyone out there doing this sort of stuff? Thanks.

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[deleted171991]

Given the ongoing pandemic we are trying to avoid having people come to the hospital. I’m a medium private practice and do preop consults as requested (mostly high risk/complex OB but a few other things). We usually have them come in and a partner sees them on the fly. Not a great setup.

Now we have an opportunity to change things up. CMS has relaxed a lot of the TeleHealth rules (can be done from home, patient doesn’t have to live in a critical access area) and I was wondering if any docs out there are doing Telehealth visits. What I have found on the ASA and CMS websites are to bill as a 60 minute critical care consult (G0508 CPT code). I have reservations about doing that routinely but honestly the coordination for the high risk / cardiac OB cases merits a critical care review and I frequently spend that much time in review/patient discussion/interdisciplinary conversations.

The idea is to get potentially some reimbursement above zero which is what we have did before. Anyone out there doing this sort of stuff? Thanks.

I am not a billing expert, but I seriously doubt that you can bill an outpatient preop as a critical care consult. Anesthesia (preop) is NOT critical care, regardless how complicated the patient is. You're wearing your anesthesiologist hat, not your intensivist hat.

My guess is that code was invented for (tel)eICU purposes.

"G0508 is a valid 2020 HCPCS code for Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth or just “Crit care telehea consult 60” for short, used in Medical care."

G0508 - HCPCS Code for Crit care telehea consult 60

HCPCS Code G0508 for Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth.

hcpcs.codes

 

[AdmiralChz]

I am not a billing expert, but I seriously doubt that you can bill an outpatient preop as a critical care consult. Anesthesia (preop) is NOT critical care, regardless how complicated the patient is. You're wearing your anesthesiologist hat, not your intensivist hat.

My guess is that code was invented for (tel)eICU purposes.

"G0508 is a valid 2020 HCPCS code for Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth or just “Crit care telehea consult 60” for short, used in Medical care."

G0508 - HCPCS Code for Crit care telehea consult 60

HCPCS Code G0508 for Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth.

hcpcs.codes

Okay.

I got the idea from our state academic hospital which does this for preop appointments and bills successfully. Was wondering if anyone else had any insight.

 

[deleted171991]

Okay.

I got the idea from our state academic hospital which does this for preop appointments and bills successfully. Was wondering if anyone else had any insight.

With CMS, you're "successful" until you're audited. Then you're fined and penalized, successfully.

I honestly doubt that an outpatient would EVER qualify for a critical care code (unless he's crashing and you're doing teleICU with the paramedics etc.).

Just think about it. This is still a usual preop, with the usual billing and complexity, it's just in a different location. See what ophthalmologists do: Coding for Phone Calls, Internet and Telehealth Consultations . This is still a 99241-99245, with a -95 modifier.

"Telemedicine is defined by a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician.

• The examination and communication of information exchange between the physician and the patient must be the same as when rendered face-to-face.
• Code level selection is based on same criteria for the base codes.
• Non-HIPAA compliant communications platforms are allowed during the emergency as long as they are not public facing (see HIPAA reference below)
• Telemedicine codes are identified by an asterisk (*) in your CPT book
• Appending modifier -95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications systems) is optional during the public emergency.
• List place of service as 02"

 

[narcotics999]

How much is 60mins critical care consult for medicare?

 

[Consigliere]

How much is 60mins critical care consult for medicare?

42 cents

 

[AdmiralChz]

With CMS, you're "successful" until you're audited. Then you're fined and penalized, successfully.

I honestly doubt that an outpatient would EVER qualify for a critical care code (unless he's crashing and you're doing teleICU with the paramedics etc.). Just think about it.

We won’t get fined it just won’t get paid (as I probably don’t meet criteria) which is fine as it’s a service we don’t get paid for now. You can bill for a “phone call” through CMS for something like $32. I am still investigating. There really should be some sort of coding for this, but then again I guess most academic preanesthesia clinics don’t bill anything anyway?

Somehow Telehealth ICU consults ARE absolutely allowed. They were allowed before the CMS relaxations for COVID as well. I don’t know many details, but the code is clearly there.

 

[sigrhoillusion]

I don't believe anesthesia preops can be billed separately. It's an all inclusive kind of thing. I remember talking to our chairman a few months ago in regards to inpatient preops as well as our pre-admission testing site, and they're pretty much wastes of money.