Conquer Inpatient Telemedicine Consultations

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:

• A physician requests the inpatient consultation service from another physician or qualified NPP. Inpatient telehealth consultations are distinguished from other inpatient evaluations and management (E/M) visits by this request.

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.

• A consultant needs to document the request for the inpatient telehealth consultation from an appropriate source and the need for an inpatient telehealth consultation (i.e., the reason for a consultation service).

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.

• The consultant needs to prepare a written report of his/her findings and recommendations. She should also give a copy to the referring physician.

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:

• Reviewing the patient’s diagnostic imaging and lab work
• Communicating with other professionals or family
• Documenting the visit in the patient’s chart
• Discussing the results of the telemedicine consultation
• Developing further care plans

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:

• G0425 (Telehealth consultation, emergency department or initial inpatient, typically 30 minutes…) Assign this code when your practitioner performs a problem focused history and exam, and engages in medical decision making that is straightforward. For this level of service, your practitioner typically spends 30 minutes communicating with the patient via telehealth.
• G0426 (Telehealth consultation, emergency department or initial inpatient, typically 50 minutes…) Assign this code when your practitioner performs a detailed history and exam, and engages in medical decision making that is of moderate complexity. For this level of service, your practitioner typically spends 50 minutes communicating with the patient via telehealth.
• G0427 (Telehealth consultation, emergency department or initial inpatient, typically 70 minutes…) Assign this code when your practitioner performs a comprehensive history and exam, and engages in medical decision making that is of high complexity. For this level of service, your practitioner typically spends 70 minutes or more communicating with the patient via telehealth.

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:

• Monitoring progress
• Suggesting management modifications
• Recommending a new plan of care based on changes in the patient’s status
• Coordinating care with other providers or agencies
• Communicating with other professionals
• Reviewing patient data
• Discussing the case with the patient’s family
• Completing medical records or other documentation
• Communicating the results of the consultation

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:

• G0406 (Follow-up inpatient telehealth consultation, limited…) Assign this code when your practitioner spends 15 minutes communicating with the patient via telehealth.
• G0407 (Follow-up inpatient telehealth consultation, intermediate…) Assign this code when your practitioner spends 25 minutes communicating with the patient via telehealth.
• G0408 (Follow-up inpatient telehealth consultation, complex…) Assign this code when your practitioner spends 35 minutes communicating with the patient via telehealth.

Learn More

Get you up to speed on telehealth billing, coding, denials, and everything between with The Telemedicine & Telehealth Handbook for Medical Practices.