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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