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Understanding How to Use & Bill with New Virtual Check-in Codes


 

What are virtual check-in codes? How can they affect your practice? And why are they important?

As part of its 2019 Medicare Physician Fee Schedule released in November, the Centers for Medicare & Medicaid Services (CMS) included new codes that apply when a physician remotely evaluates a patient via a telephone call or an image to determine whether the patient will require an office visit.

These new codes - categorized as "virtual check-in codes" - can be applied if the evaluation does not lead to an office visit and doesn't occur within seven days of a prior evaluation and management service by the provider. The "brief communication technology-based service" must be conducted by a physician or other qualified healthcare professional who can report evaluation and management (E/M) services. The new codes also can be billed as a separate standalone service.

As part of the 2019 Medicare Physician Fee Schedule, two HCPCS codes were added. They are:

HCPCS G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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.

It is important to remember this HCPCS code is only billable if the evaluation is performed by a provider qualified to furnish and bill for evaluation and management service.

HCPS G2012: Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified healthcare professional who can report evaluation and management services, provided to an established patient, 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; 5-10 minutes of medical discussion.

This code requires direct interaction between the patient and the billing practitioner. Again, it's important to remember this HCPCS code is billable only if the evaluation is performed by a provider qualified to furnish and bill for evaluation and management service.

Things to remember when utilizing these HCPCS codes:

  • These codes can be used for established patients only. CPT defines an established patient as one who has received professional services from the physician or qualified healthcare professional or another physician or qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years.
  • The physician must obtain and document patient consent. The consent is not a blanket consent. A consent must be obtained each time this type of service is requested.
  • There is no frequency of use limitation for 2019.
  • No service specific documentation requirements have been published. Documentation for virtual check-ins is consistent with the requirements for other Medicare-covered physician services.
  • The patient is responsible for a co-payment for this service.

Virtual check-in services are covered by CMS, as well as many other payers. The table below reflects Palmetto 2019 Part B physician fee schedule payment. Most payers find virtual check-ins attractive because they may save an office visit. However, you would need to check with each payer individually to see if these codes are covered.

Payment for these codes individually might not appear to be a lot, but once policies and procedures are put in place to cover the requirements for utilizing these codes efficiently and effectively, this can - over time - represent a significant amount of money for a practice dependent on specialty.


Stacey Stuhrenberg is a senior consultant in the coding and compliance practice of Kraft Healthcare Consulting LLC, an affiliate of KraftCPAs. She consults with healthcare providers regarding billing and coding compliance, performs coding and documentation audits, and helps educate providers. For questions about how virtual check-in codes could affect your healthcare practice, contact her at stacey@krafthealthcare.com.

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Tags:
2019 Medicare Physician Fee Schedule, HCPCS G2010, HCPCS G2012, Kraft Healthcare Consulting, KraftCPAs, Stacey Stuhrenberg, Virtual Check-in Codes
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