Billing for Telemedicine in Chiropractic

January 14th, 2020 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
Categories:   CPT® Coding   Chiropractic   Evaluation & Management (E/M)   Modifiers  
0 Votes - Sign in to vote or comment.

Twenty percent of Americans live in rural areas, but they are only served by nine percent of health care providers. Telemedicine is a way for these patients to be able interact with providers when it may be difficult or impractical to see them in person. These types of encounters could provide revenue to the provider while also improving patient compliance and reducing their expenses associated with transportation. Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.

At the time that this article was written, thirty-seven states had parity laws in place which require payers to cover telemedicine to the same extent as face-to-face services. Fourteen states have special licenses for practicing telemedicine across state lines, but the rules vary from state to state. It appears that all of the states with parity laws require private payer reimbursement for live video encounters, while only some require coverage for asynchronous, or store-and-forward encounters. Note that typically audio-only interaction is not covered. This includes:

For the most part the parity laws require that the reimbursement for telehealth are mandated to be the same amount as if the service were provided in person. However, some states leave it up to the payers. And, in some cases, small group or work comp plans have the option to opt out. Be sure to check with your state and the health plan before attempting to bill for telemedicine.

Medicare (CMS) has specified that they cover asynchronous, store-and-forward telemedicine in only Alaska and Hawaii as part of a special program. And CMS has required that the patient must travel to a qualified originating site (where the patient is at the time of the encounter) for synchronous, or live video encounters. For Medicare, these sites do not include the patient’s residence, which would greatly limit telehealth application in a chiropractic setting.

Fortunately, parity laws in most states remove this cumbersome requirement, but it is still best to check with each health plan. Of course, at the time of publication of this article, CMS only reimburses for chiropractic manipulation anyway, and that cannot be performed via telemedicine. However, some payers may follow the CMS standard, so it is important to be familiar with Medicare policies.

The most likely type of encounter that a chiropractor might bill via telemedicine would be an established patient evaluation and management (E/M) counseling encounter from the codes for 99212 through 99215. This type of encounter requires documentation of a time override rather than  the typical E/M encounter which requires documentation of the three key components: history, exam, and medical decision making. “Counseling” is defined in the CPT book as discussion with the patient and/or family concerning one or more of the following areas:

These things would need to be documented in the encounter as well as time. The current time requirements for these E/M codes are as follows:

For a an in office encounter the face-to-face time must equal at least half of the total time. For telemedicine, it seems that it would represent the entire encounter since the provider and patient would be video conferencing.

Additional documentation requirements may vary again by payer or state, but in general they should include:

When billing for telemedicine the place of service code that goes in Item Number 24b on the 1500 Claim Form should be 02 to indicate telehealth. Typically the 95 modifier should also be attached to the CPT code. (See Appendix P of the CPT code book for AMA’s full list of telemedicine-eligible codes.) Medicare has two of their own modifiers, depending on the type of telehealth. Some payers may recognize them, therefore they are included below. The options are:

Though it may seem like it has limited application in a chiropractic setting, patients could be better served, and the provider may be able to generate additional revenue by following the scenario outlined above.


Dr. Evan Gwilliam is a chiropractor and certified professional coder and auditor. He is the clinical director for PayDC, a completely integrated EHR software. He can be reached at evan.gwilliam@paydc.com.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

A 2020 Radiology Coding Change You Need To Know
February 10th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...
Documenting telephone calls at your dental practice is just as important as documenting patient visits.
February 4th, 2020 - Christine Taxin
Documenting telephone calls at your dental practice is just as important as documenting patient visits. Similar to other documentation, the common rule when it comes to call documentation is that if it is not documented, it did not happen. Therefore, every clinically relevant telephone call should be documented. Clinically relevant calls ...
CPT 10-Year Historical Content - Now Available!
January 22nd, 2020 - Find-A-Code
Did You Know? We now offer Historical CPT Content in 2-year, 5-year, or 10-year options! Utilize access to specific CPT historical data for previous years using rules effective at that specific time. If you’ve added UCR fees to your account, you can use Historical CPT Content to view UCR fees from ...
Inadequate Exclusion Screenings Could Put Your Practice at Risk
January 21st, 2020 - Wyn Staheli, Director of Research
Exclusion screenings require far more than just checking a name on a federal database at the time you are hiring someone. Far too many providers don’t realize that in order to meet compliance requirements, there is MUCH more involved. There are actually over 40 exclusion screening databases/lists that need to be checked.
Q/A: How do we Bill Massage Services?
January 21st, 2020 - Wyn Staheli, Director of Research
Question: We are adding a massage therapist soon and have some questions about billing their services.
Billing for Telemedicine in Chiropractic
January 14th, 2020 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
Non-Surgical Periodontal Treatment
January 14th, 2020 - Christine Taxin
AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.SCALING AND ROOT PLANINGScaling ...



About Codapedia by innoviHealth® Contact Us Terms of Use Privacy Policy Advertise with Us

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2020 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association