E/M Coding Recommendations

We recommend billing telemedicine visits just like in-office visits. Each visit requires a procedure code, a diagnosis code, and a telemedicine indicator. A telemedicine indicator can be either a telemedicine modifier code or Place of Service 02 code.

In this article, we will review the most commonly used E/M procedure codes for telemedicine.

Telemedicine for Established Office Patients

Two out of three of the following components are required in order to file a claim for established patients over a telemedicine encounter. Time-based billing may also be used.

1
History
2
Physical Exam (visual  exams typically not needed for billing requirements)
3
Medical Decision Making
Level E/M Code History Physical Exam
(typically not needed)
Medical Decision Making Time
2 99212 Problem Focused Problem Focused Straightforward Complexity 10 min
3 99213 Expanded Problem Focused Expanded Problem Focused Low Complexity 15 min
4 99214 Detailed Detailed Moderate Complexity 25 min

Telemedicine for New Office Patients

All three of the following components are required in order to file a claim for new patients over a telemedicine encounter. Time-based billing may also be used.

1
History
2
Physical Exam (visual exams needed for billing requirements)
3
Medical Decision Making
Level E/M Code History Physical Exam
(visual exam needed)
Medical Decision Making Time
2 99202 Expanded Problem Focused Expanded Problem Focused Straightforward Complexity 20 min
3 99203 Detailed Detailed Low Complexity 30 min

Additional CPT Codes:

The AMA 2018 CPT book includes a list of CPT codes billable with telemedicine. The AMA uses a symbol of a star to indicate when a code is allowed for use with telemedicine. 

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