What is Telehealth and what changes are coming in 2016What is Telehealth? 



As technology expands, the role it plays in our lives and our healthcare continues to evolve and expand as well. With new technology comes new methods for healthcare delivery, cost savings, and creative solutions for improving quality patient care. Telehealth is an expanding field and we are finally seeing CMS and other payers begin to recognize the benefits provided by telehealth services and begin to pay for those services.

Telehealth is the use of technology for the delivery of health care, health information, or health education at a distance. Although there are several applications used for telehealth, the most popular applications are teleradiology, continuing professional education, and home monitoring. Teleradiology is used to send test results to another facility for diagnosis; continuing professional education consists of presentations given by specialists to general practitioners; and home monitoring is provided by nurses as a supplement to home visits.

Telehealth consists of two general types of applications. One is referred to as real-time communication, and the other is called store-and-forward. Real-time is when a patient and nurse practitioner consult with a specialist by way of an audio-visual link, or when a doctor and patient communicate in an exam room via an interpreter through the phone or webcam. Another example of real-time communication would be if, say, a cardiologist holds a teleconference with internists about new best practices in treating angina. Store-and-forward is when digital images, such as in radiology or dermatology, are transmitted for diagnosis.

It is important to note that all telehealth applications require health information technology (IT), but not all uses of health IT are considered telehealth. Examples of non-telehealth applications would be such stand-alone systems as electronic health records (EHRs) and computerized decision support (CDS).

In summary, telehealth is a way to increase the communication between a patient and the health system, and it can also bring more expertise to consult on a case, reaching out to patients when they live far from the facility. This technology not only eliminates the time it takes to travel, but it also reduces the expense for both physicians and patients, and is beneficial to improving preventative medicine and the treatment of chronic conditions.

What Changes Are Coming In Telehealth?

January 1, 2015, the Physician Fee Schedule Final Rule released by CMS put into effect some major changesin telehealth services. Reimbursement rates increased with regard to telehealth services to telehealth originating locations by 0.8 percent. Also, there were seven new reimbursement codes for 2015 related to telehealth. They included:

  • Psychotherapy services (CPT® codes 90845, 90846, and 90847)
  • Prolonged services in the office (CPT® codes 99354 and 99355)
  • Annual wellness visits (HCPCS codes G0438 and G0239)

As far as billing is concerned, the originating site fee was $24.83.

There was also a new CPT® code 99490, which permits doctors to bill Medicare for management of chronic care when a patient has two or more chronic conditions, including heart failure and diabetes. The monthly, unadjusted, non-facility fee is $42.60. Since 99490 is a physician service, it is available across the country and not just for rural telehealth. Therefore, patients are not expected to be present. CPT® code 99490 can be bundled with 99091 for the collection and interpretation of physiologic data, but CMS still does not allow any further reimbursements for this service. They do, however, allow providers to count the data review time invested toward the monthly minimum time for billing for chronic care management.

CMS also allowed two valuable service codes:

  • 99090 – Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data).
  • 99091 – Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.

Remote patient monitoring of chronic conditions is paid by Medicare with a monthly, unadjusted, non-facility fee of $56.92 when using CPT® code 99091. Previously, they only covered services when they were bundled with evaluation and management codes.

Traditionally, Medicare has provided little coverage for telehealth services. However, the 2015 CMS rule change was a big step and allows physicians to improve costs and quality of healthcare by using telehealth technology. Therefore, it is imperative that medical coders and billers understand how to accurately bill for these services.

By Debbie Jones, CPC-A, CCA