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. Once your practice has determined how you will be utilizing telemedicine/telehealth and the location of the patient (originating site rule), the best practice prior to submitting claims is to research your major insurance payers.  Once you have navigated the landscape for a single patient, it will become routine and work like any other in-office billing procedure. 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.  (Please refer to your state guidelines regarding establishing a physician-patient relationship via telemedicine)

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 2019 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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