Billing & Attestation Guide

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Attestation/Disclosures

Telemedicine Informed Consent

The risks, benefits, and alternatives to Telehealth consultation were explained to the patient and the patient or family verbally consented to this modality of care. Any physical exam was assisted by nursing personnel or local provider.
--- OR ----
Due to critical illness and patient inability to consent and due to emergent nature of patient clinical condition, implied consent to provide Telehealth care was applied.

TeleConsult Attestation

Teleneurology is a consultative service supporting the local providers for this patient. Relevant patient information, acquired through discussion with emergency providers, independent assessment, and review of the local EMR, is to be shared with the teleneurologist at the time of consultation request. The Acute Teleneurology team should be contacted with any neurologic worsening or clinical changes, new test results, or new patient history that is reported to or discovered by the local team following completion of the teleneurology consultation, specifically that which has the potential to impact the consultative recommendations

Resident/Fellow/NP Attestation Brief

I, *** personally examined the patient, reviewed the history and examination with the nurse practitioner *** and together we formulated the above plan

Resident/Fellow/NP Attestation Long

Providing Physician Attestation
I reviewed events, examined the patient and discussed management and plan with treatment team. Agree with examination findings and assessment and plan as noted above with following opinions of my own.
 
Briefly, *** <Name>
 
Exam
*** <Vitals>
Alert vs Somnolent vs Obtunded vs Comatose Oriented x *** <#>
<Mild/Moderate/Severe> Aphsia
Follows commands: *** <Yes Consistently, Yes Intermittently, No>
PERRLA, EOMI, *** <Mild/Moderate/Severe> Dysarthria
LUE RUE
LLE RLE
 
Assessment and Plan
I collaborated with formation of above stated plan and agree with documentation. Salient Plan for today;
***
 

Time Based Billing

Time Based Billing requires at least three components for Documentation;
Why: Chief complaint and brief HPI
What: Face to face encounter via real time audio/video (Live)
Time: How much time you spent delivering and coordinating care.
Technically following line satisfies billing criteria - “58M with right-sided weakness NIHSS 4 spent 40 mins”
However, documentation is not only done for billing; but rather also for communication and continuity of care. So please be brief, concise and poignant in your documentation.

Critical Care Billing Attestation

This patient is critically ill due to acute impairment of the multiple system as a result of *** with high probability of imminent or life threatening deterioration in the patient’s condition that requires ICU management.
I provided *** minutes of critical care to this patient. The care that I provided includes detailed clinical assessment, interpretation of multiple physiological parameters, high complexity decision making to assess, manipulate, and support vital system function to treat multi system failure and to prevent further life threatening deterioration of the patient's condition.
— OR —
I provided *** minutes of Critical Care to this patient. This included review of recent events, clinical examination and review of data on multiple occasions, management of multiple organ systems, and discussion about treatment with the members of the multidisciplinary ICU team and documentation. This time does not include time spent in performing any separately billed procedures.
— OR —
This patient is critically ill due to an acute impairment of the following system(s):
This is the result of the following conditions that have a high probability of causing imminent life threatening deterioration that requires my personal management:
I provided *** minutes of critical care to this patient. This includes a review of recent events and medical history, detailed clinical examination at the bedside, interpretation of multiple physiological parameters, laboratory data and imaging studies. I performed high complexity decision making to assess, manipulate, and support vital functions as well as discussed the patient's care with members of the multidisciplinary ICU team and other medical providers. Additionally, I personally performed the following actions at the patient’s bedside:
This time DOES NOT include time spent in performing any separately billed procedures or time spent by providers of other specialties performing critical care services.
— OR —
The patient is critically ill and requires high complexity decision making for assessment and support including: frequent evaluation and titration of therapies; extensive interpretation of multiple databases; application of advanced monitoring technologies and assessment and treatment of complex metabolic derangement.
Care during the described time interval was provided by me. I have reviewed this patient's available data, including medical history, events of note, physical examination and test results, and have overseen the activities of other members of the care team under my direct supervision (e.g. house officers, nurse practitioners). 
Critical care time, exclusive of procedures, was *** minutes.

Time Based E/M Billing Attestation

Counseling: Discussed diagnosis and prognosis with *** <Patient, Family, Team etc.>.
Coordinating: Reviewed plan of the day with nurse, nurse practitioner, pharmacist, PT/OT/Speech services, Social worker, charge nurse and other team members.
I provided *** <Time> of patient care at bedside. This included review of recent events, clinical examination and review of data on multiple occasions, management of multiple organ systems, and discussion about treatment with the members of the multidisciplinary team and documentation. More than 50% of time was spent in counseling and coordinating care of the patient. This time does not include time spent in performing any separately billed procedures.

Digital Voice Disclosure

Portions of this note may be dictated using provided default voice recognition software. There might be spelling and vocabulary errors which are unintentional. Not all areas are caught/corrected. Please notified out or if any discrepancies noted or if the meaning of any statement is not clear

Billing

Remote Physiologic Monitoring (RPM)

Code
Description
99453
Remote monitoring of physiological parameters (e.g. weight, blood pressure, respiratory flow rate, pulse oximetry). Covers initial set-up and patient education on use of equipment.
99454
Remote monitoring of physiologic parameters (e.g. eight, blood pressure, respiratory flow rate, pulse oximetry). Covers initial device supply with daily recordings or transmission of programmed alerts [minimum of 16 readings each 30 days]
99457
Remote physiologic monitoring treatment management service. Covers 20 minutes or more of time spent with clinical staff/physician or other qualified healthcare professional. This code requires at least one interactive communication with the patient/caregiver during the month.
99458
Remote physiologic monitoring treatment management service.Covers clinical staff/physician/other qualified health care professional time in calendar month requiring interactive communication with the patient/caregiver during the month which can be billed up to two times a month; every additional 20 minutes to be listed separately in addition to code for primary procedure.
99091
Collection and interpretation of physiologic data (e.g ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.

Critical Care Billing

Code
Tags
99291
30 -74 mins
99292
Each Additional 30 mins

Telemedicine Billing

Inpatient Face-to-Face

Type of Service
Defining Service
CPT Code
Inpatient - Initial
Real time (Live) Audio & Video in emergency/Inpatient setting for NEW patients
G0425 - 30 Mins G0426 - 50 Mins G0427 - 70 Mins
Inpatient - Subsequent
Real time (Live) Audio & Video in emergency/Inpatient setting for ESTABLISHED  patients
G0406 - 15 mins G0407 - 25 mins G0408 - 35 mins
Critical Care - Prolonged
Real time (Live) Audio & Video in emergency/Inpatient setting for NEW/ESTABLISHED
G0508 - 60 mins G0509 - 50 mins
Inpatient - Pharmacy
Telehealth inpatient pharmacy management
G0459
 

Outpatient Face-to-Face

Type of Service
Defining Service
CPT Code
Outpatient - Initial
Real time (Live) Audio & Video in an office/outpatient setting for NEW patients
99201 - 10 mins 99202 - 20 mins 99203 - 30 mins 99204 - 45 mins 99205 - 60 mins
Outpatient - Subsequent
Real time (Live) Audio & Video in an office/outpatient setting for ESTABLISHED patients
99211 - 05 mins 99212 - 10 mins 99213 - 15 mins 99214 - 25 mins 99215 - 40 mins

Outpatient NON Face-to-Face

Type of Service
Defining Service
CPT Code
Phone Call *
Phone call UNRELATED to past (>7days) and future (soonest apt)
99441 - < 10 mins 99442 - < 20 mins 99443 - < 30 mins
eVisit **
Communication b/w patient-initiated communications and provider through an secure online portal
99421 - < 10 mins 99422 - < 20 mins 99423 - > 21 mins
* E.g; Established patient with new complain which does not require an office visit
** E.g; Prescribed Topiramate, how to take meds; second question about GI upset. Cumulatively you spent 15 mins via secure chat bill 99422 during the 7 days. In all types of locations including the patient’s home, and in all areas. Know when not to bill online services - Followed by E/M services or post procedure check-in
Originating Site Facility Fee - Q3014 (the telehealth originating site facility fee) will be 80% of the lesser of the actual charge or $26.56
Virtual Check-in - Not worth the effort of Documentation or discussion - $14.81

In-Person E&M Billing

Inpatient Initial

Code
Time
History
Exam
Decision Making
99221
30
Detailed
Detailed
Low Complexity
99222
50
Comprehensive
Comprehensive
Moderate Complexity
99223
70
Comprehensive
Comprehensive
High Complexity

Inpatient Subsequent

Code
Time
Interval Problem
Exam
Decision Making
99231
15
Focused
Focused
Low Complexity
99232
25
Focused
Expanded
Moderate Complexity
99233
35
Detailed
Detailed
High Complexity

Outpatient Initial

Code
Time
History
Exam
Decision Making
99201
10
Focused
Focused
Straight Forward
99202
20
Expanded
Expanded
Straight Forward
99203
30
Detailed
Comprehensive
Low Complexity
99204
45
Comprehensive
Comprehensive
Moderate Complexity
99205
60
Comprehensive
Comprehensive
High Complexity

Outpatient Established

Code
Time
History
Exam
Decision Making
99211
5
99212
10
Focused
Focused
Straight Forward
99213
15
Expanded
Expanded
Low Complexity
99214
25
Detailed
Detailed
Moderate Complexity
99215
40
Comprehensive
Comprehensive
High Complexity

EEG Billing

Routine Electroencephalography (EEG)

CPT Code
Description
95816
Awake & Drowsy
95819
Awake & Asleep
95822
Coma or Sleep
95812
41-60 minutes
95813
> 60 minutes
 

Long Term EEG Professional Codes

Recording TYpe
2-12 hr
12-26 hr
30-60 hr
60-84 hr
> 84 hr
EEG w/o Video
95717
95719
95721
95723
95725
EEG WITH Video
95718
95720
95722
95724
95726
 

Long Term EEG Technical Codes

Recording Type
Duration
Unmonitored
Intermittent
Continuous
EEG w/o Video
2-12 Hr
95705
95706
95707
EEG w/o Video
12-26 Hr
95708
95709
95710
EEG WITH Video
2-12 Hr
95711
95712
95713
EEG WITH Video
12-26 Hr
95714
95715
95716
 

Long-Term Monitoring ICU/EMU (95950-95956)

CPT Code
Tags
95950
Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic (eg, 8 channel EEG) recording and interpretation, each 24 hours – $330 – $360
95951 *
Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation (eg, for presurgical localization), each 24 hours
95952
Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended

* Modifier 52 - Indicate the service was reduced in some way

 
 
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