Inpatient consultations via telemedicine is improving lives. These encounters facilitate the delivery of certain services that might otherwise be unavailable to a patient located at an originating site.
While you can’t use telemedicine to provide E/M inpatient encounters, you can use them to substitute for a face-to-face encounter for initial and follow-up inpatient consultations, as well as for specialist consultations to discuss advice and recommendations physician-to-physician.
Medicare pays for reasonable and medically necessary inpatient telehealth consultation services furnished to beneficiaries in hospitals or SNFs when your facility meets the following criteria for the use of a consultation code:
Important: The qualified NPP may perform consultation services within the scope of practice and licensure requirements for NPPs in the state in which he/she practices.
Note: The consultant needs to place this information in the patient’s medical record and the requesting physician or qualified NPP should include the same information in the patient’s plan of care in the medical record.
Nail down initial inpatient telehealth consultation
The physician of record or the attending physician requests the initial inpatient telehealth consultation for her patients located in hospitals or SNFs.
Caution: The physician or practitioner who furnishes the initial inpatient consultation via telehealth cannot be the physician of record or the attending physician.
Key: This initial inpatient telehealth consultation is distinct from care that the physician of record or the attending physician provides.
Power up payments for initial inpatient telehealth consultations
Your Medicare reimbursement for the consultation would include all related services furnished before, during, and after communicating with the patient via telehealth.
These services include, but are not limited to:
Heads up: You should not bill an additional E/M service for work related to an initial inpatient telehealth consultation.
The following codes show a sample of the requirements necessary for you to bill for an inpatient telemedicine consultation:
Learn when to bill follow-up inpatient telehealth consultations
Use telemedicine to manage follow-up inpatient telehealth consultations furnished to patients in hospitals or SNFs. These encounters can only occur after the patient’s initial consultation. The attending physician needs to request these consultations.
Tip: The initial inpatient consultation could have been provided as either as an in-person encounter or a telemedicine visit.
Important: The physician or practitioner who furnishes the inpatient follow-up consultation via telehealth cannot be the physician of record or the attending physician.
Key: The follow-up inpatient consultation is distinct from the follow-up care that the physician of record or the attending physician provides.
Caution: If a consultant has initiated treatment at an initial consultation and continues to participate in the patient’s ongoing care management, do not include this care in the definition of a follow-up inpatient consultation. It is not appropriate for delivery via telehealth.
Increase your reimbursement for follow-up telemedicine consultations
You can receive Medicare reimbursement for follow-up inpatient telehealth consultations. This reimbursement will include all consultation related services furnished before, during, and after communicating with the patient via telehealth.
Follow-up inpatient telehealth consultations could include, but are not limited to, the following services:
Remember: You cannot bill an additional E/M service for work related to a follow-up inpatient telehealth consultation.
The following codes show a sample of the requirements necessary for you to bill for a follow-up inpatient telemedicine consultation:
Get you up to speed on telehealth billing, coding, denials, and everything between with The Telemedicine & Telehealth Handbook for Medical Practices.