Telehealth billing codes
What are the billing codes specific to Telehealth?
· Billing codes for telehealth are the same, yet they are modified using .95
· Initial Outpatient Visit: 99205.95
· Established Outpatient: Visit 99214.95
· Psychiatric Evaluation: 90792.95
· Psychotherapy with E/M: 99213.95, 90833.95 (AACAP, 2022)
2. What is the Ryan Haight Act and what are the 7 exceptions to this Act? The Ryan Haight Act of 2009 is a regulation act set forth in which practitioners are to govern themselves. Further, an emphasis is on prevention of illegal distribution of controlled substances via the internet. This act is a form of consumer protection (i.e., treating patients utilizing telemedicine and prescribing controlled medication). It is specific to patient, location, clinic, hospital, practitioner and practice, applicable to state law (Lactman, n. d).
· Treatment in a hospital or clinic
· Treatment in the physical presence of a practitioner
· Indian Health Service or tribal organization
· Public health emergency declared by the Secretary of
· Health and Human Services
· Special registration
· Department of Veterans Affairs medical emergency
· Other circumstances specified by regulation
3. Describe a scenario that would allow an exception for controlled substances prescribing for a Telehealth visit.
As per The United States declaring COVID 19 a public health emergency, the government invoked an exception of the Ryan Haight Act of 2008. With the exception it allows DEA registered prescribers to continue prescribing controlled substances after conducting the initial telemedicine visit either by telephone or two way audio visual communication. As the law currently stands, this exception is only effective during the time of the public emergency (Wang et al., 2021).
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Scenario: A client is seen for opiate abuse. The client in conjunction with his treatment team (i.e. client, addiction counselor, PMHNP) collaborate and develop a plan for treatment. The PMHNP prescribes buprenorphine as a pharmacological treatment during his telehealth visit as long as the prescription is for legitimate medical use. Due to buprenorphine being a scheduled III medication, this scenario would fall under a declared public emergency exception of the Ryan Haight Act of 2008 (Wang et al.,2021).
4. What documentation is necessary to include for a Telehealth visit?
· Date of the visit.
· Consent for visit from patient or patient representative (verbal or written).
· Category for office visit—real-time audio with video or audio/telephone only.
· Date the patient was last seen or was billed for correspondence to avoid date overlap with other billable services.
· Patient location for the visit.
· Provider location for the visit.
· Names and roles of all participants
· Start time and end time for telehealth encounter (length of time billing provider spent on the day of the visit and how time was spent if billing by time or a time-based code) (Houser et al., 2022).
This is an exemplary post. The provided billing codes specific to telehealth are correct. However, I would like to add that there are more telehealth billing codes, particularly specific to COVID-19 and they include 99442 (11-20 minutes), 99441 (5-10 minutes), and 99443 (20-30 minutes) (Rogers, 2021). The Ryan Haight Act and the seven exceptions to the Act are also well illustrated. According to Breitinger et al (2020), the Ryan Haight Act is enforced by Drug Enforcement Agency (DEA) and it was created to regulate online prescriptions and enforce regulations regarding the prescription of controlled substances through telehealth. The Ryan Haight Act requires practitioners prescribing controlled substances to perform medical evaluation apart from the exemptions (Breitinger et al., 2020). The provided scenario on the exemption for controlled substances prescription through telehealth is classic where a client seen for opiate abuse is prescribed buprenorphine via a telehealth visit. Buprenorphine is a scheduled III drug; this patient visit is covered under the public emergency exception of the Ryan Haight Act. You have also clearly indicated the documentation necessary for a telehealth visit. Adequate documentation of telehealth visits is necessary in order to ensure appropriate coding and billing and thus facilitate maximum reimbursement (Bajowala, Milosch & Bansal, 2020). Practitioners should ensure that suitable evaluative and management CPT codes are used.
Bajowala, S. S., Milosch, J., & Bansal, C. (2020). Telemedicine Pays Billing and Coding Update. Current Allergy and asthma reports, 20(10), 60. https://doi.org/10.1007/s11882-020-00956-y
Breitinger, S., Gentry, M. T., & Hilty, D. M. (2020). Key Opportunities for the COVID-19 Response to Create a Path to Sustainable Telemedicine Services. Mayo Clinic Proceedings, 95(12), 2602–2605. https://doi.org/10.1016/j.mayocp.2020.09.034
Rogers J. (2021). Coding telehealth services during COVID-19. The Nurse practitioner, 46(2), 10–12. https://doi.org/10.1097/01.NPR.0000731584.40074.eb