Teleneurology Billing and Coding
Telemedicine is the prompt provision of healthcare facilities from a remote location, allowing a patient to receive medical attention without being physically present in the clinical scenario. Several neurology applications have been undertaken in telemedicine, the most prominent of which is telestroke.
Teleneurology has been applied in general neurological practices for the past four to six years, along with monitoring ICU patients, inpatient neurological conditions, and sub-specialty outpatient care. The COVID-19 pandemic expedited its propagation, resulting in the widespread use of teleneurology across the United States and worldwide.
This writing focuses on billing for teleneurology and delves into the billing codes typically used by healthcare providers in this domain.
Coding by Time
Healthcare providers ensure accurate teleneurology billing by applying their understanding of evaluation and management (E/M) coding, including ways to code by either time-based coding or medical decision-making. Most healthcare providers consider coding by time through the following CPT codes since telemedicine precludes a complete neurological examination:
New Patient Visits
99201
Typical Time: 10 minutes
99202
Typical Time: 20 minutes
99203
Typical Time: 30 minutes
99204
Typical Time: 45 minutes
99205
Typical Time: 60 minutes
Established Patient Visits
99211
Typical Time: 5 minutes
99212
Typical Time: 10 minutes
99213
Typical Time: 15 minutes
99214
Typical Time: 25 minutes
99215
Typical Time: 40 minutes
Medicare and several private payers reimburse telephone E/M neurological services through the following telephone evaluation and management coding by time CPT codes:
99441
Typical Time: 5 to 10 minutes
99442
Typical Time: 11 to 20 minutes
99443
Typical Time: 21 to 30 minutes
A qualified healthcare provider or neurologist can also provide medical care to a new or established patient.
Virtual Communication Billing
Patients can also avail of virtual communication in teleneurology. Virtual check-ins offer concise communication through a technology-based service. They include real-time, audio-only telephonic interactions lasting five to ten minutes in medical discussion. Some other billable medical communications through technology include CPT G2010, where patients can post images or videos for a healthcare provider’s review.
However, it is crucial to note that a healthcare provider cannot submit a G2010 or G2012 for billing if they originate from a relevant E/M service administered during the last seven days or if it leads to an E/M procedure or service in the next 24 hours or the earliest available appointment.
Online Digital or E-visit Billing
Healthcare providers can bill online digital E/M or e-visits through the following billing codes:
99421
Typical Time: 5 to 10 minutes
99422
Typical Time: 11 to 20 minutes
99423
Typical Time: 21 to 30 minutes
These patient-initiated evaluation requests are billed depending on the cumulative time a qualified provider spends on a patient within seven days, not including the time spent by clinical staff. That is why healthcare providers document and track the time they spend communicating with a patient.
Some common examples of the services these codes include are secure and encrypted communications through the patient portal and email. E-visits and online digital E/M visits are not reportable on a day when a qualified healthcare professional reports E/M bills or services for care plan oversight, chronic care management, patient supervision at their home, rest home, or domiciliary, or transitional care management for the same communications.
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