Meeting the Challenges of Medical Billing and Coding for Telehealth

The rise of telehealth has led to new codes and billing practices, along with new rules and regulations. Keeping up with all the changes can be challenging, which is why more healthcare providers are outsourcing coding to an experienced RCM company.

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Telehealth/telemedicine technologies have been around for a decade or more, but their use skyrocketed during the COVID-19 pandemic to address barriers to in-person medical visits. With the rise of telehealth, new codes and billing practices came into play, along with new rules and regulations related to telehealth. Many of these are temporary and will not be in effect after the health crisis ends.

Keeping up with all these changes requires continuous training, as well as planning for post-pandemic rollbacks of rules. This is why being agile and having a coding/billing strategy are so important at this moment — and in the future.

Recapping the rise of telehealth

Telehealth has experienced a rapid rise to address and overcome the unique challenges of the global pandemic. Today, the patient and clinician can connect with real-time audio and video thanks to a wide array of digital health solutions. It’s a great alternative to in-person visits, largely because it alleviates many traditional barriers to care such as transportation, time constraints, and accessibility.

While the telehealth surge during the pandemic has worn off, it’s not going away. Telehealth options are appreciated not just by patients, but also by practitioners and major medical organizations. Even the AMA has stressed how critical telehealth is to the future of healthcare. The association — among other organizations — is making a commitment to refine tools, practices, and policies, all while ensuring fair payment for healthcare providers.

The federal government also has realized the staying power of telemedicine. Medicare is broadening its coverage of telehealth, thanks to recent policy changes. Of course, healthcare providers must accurately code these services.

Confusion surrounding telemedicine codes

While telehealth continues to transform patient care for the better, there are implementation challenges — especially when it comes to medical billing and coding.

In response to the COVID emergency, Medicare added more than 100 CPT and HCPCS codes to the telehealth services list. Since then, understanding how to accurately code telemedicine services has been one of the biggest obstacles for practitioners. So many policy changes in such a short time — along with a lack of experience documenting these new services — are putting even more stress on administrators to code claims properly.

One of the biggest issues providers contend with is defining the telehealth visit and coding it. There are three types of virtual visits, each with associated codes:

  • Telehealth (real time): CPT codes 99211-5 (current patients) and 99201-5 (new patients)
  • E-visits (online visits): CPT codes 99421-99423 and HCPCS codes G2061-G2063
  • Virtual check-ins (assessments to determine need): HCPCS code G2010 or G2012

Even at this basic level, confusion abounds for providers seeking to code claims correctly and submit them efficiently. And this is only the start.

Overcoming challenges

While there are currently more than 100 telehealth codes, this is expected to change as the effects of the global pandemic continue to wane. The telehealth codes described above depend primarily on the method of communication, and billers and coders must understand how each code is applied. Using the wrong code can delay reimbursement.

In general, there are key differences to remember when documenting in-person vs. telehealth visits:

  • Telephone codes are necessary for audio appointments, while office codes apply to telehealth visits with audio and video.
  • Other considerations apply to reimbursement, including certain state requirements making “real-time” delivery of services essential.
  • Coders must also understand the difference between the originating site and the distance site to ensure services are covered.

Healthcare providers who embrace automation by outsourcing coding to an experienced RCM company can reduce coding errors, even as codes continue to change. Tools with artificial intelligence can check for common denial causes and then find and correct clerical errors.

Telehealth is here to stay. Are you ready?

Although familiar and increasingly commonplace, telehealth is still an emerging segment of our evolving healthcare industry. Behind the scenes, billing and coding best practices continue to be developed. Expertise is difficult to come by but increasingly necessary for providers focused on revenue cycle management.

As more healthcare providers turn to an outsourced RCM provider, they’re realizing it as less of an expense and more of an investment — especially when it yields a more seamless revenue cycle.

Learn more about medical billing and coding for telehealth at