Attestation/DisclosuresTelemedicine Informed ConsentTeleConsult AttestationResident/Fellow/NP Attestation BriefResident/Fellow/NP Attestation LongTime Based BillingCritical Care Billing AttestationTime Based E/M Billing AttestationDigital Voice DisclosureBillingRemote Physiologic Monitoring (RPM)Critical Care BillingTelemedicine BillingInpatient Face-to-FaceOutpatient Face-to-FaceOutpatient NON Face-to-FaceIn-Person E&M BillingInpatient InitialInpatient SubsequentOutpatient InitialOutpatient EstablishedEEG BillingRoutine Electroencephalography (EEG)Long Term EEG Professional CodesLong Term EEG Technical CodesLong-Term Monitoring ICU/EMU (95950-95956)* Modifier 52 - Indicate the service was reduced in some way
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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.
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
I, *** personally examined the patient, reviewed the history and examination with the nurse practitioner *** and together we formulated the above plan
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>
Alert vs Somnolent vs Obtunded vs Comatose Oriented x *** <#>
Follows commands: *** <Yes Consistently, Yes Intermittently, No>
PERRLA, EOMI, *** <Mild/Moderate/Severe> Dysarthria
Assessment and Plan
I collaborated with formation of above stated plan and agree with documentation. Salient Plan for today;
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.
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.
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.
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
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.
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]
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.
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.
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.
30 -74 mins
Each Additional 30 mins
Type of Service
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
Type of Service
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
Type of Service
Phone Call *
Phone call UNRELATED to past (>7days) and future (soonest apt)
99441 - < 10 mins 99442 - < 20 mins 99443 - < 30 mins
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
Awake & Drowsy
Awake & Asleep
Coma or Sleep
> 60 minutes
> 84 hr
EEG w/o Video
EEG WITH Video
EEG w/o Video
EEG w/o Video
EEG WITH Video
EEG WITH Video
Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic (eg, 8 channel EEG) recording and interpretation, each 24 hours – $330 – $360
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
Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended