Understanding how to use and bill with new virtual check-in codes

What are virtual check-in codes? How can they affect your practice? Why are they important?

As part of its 2019 Medicare Physician Fee Schedule released in November, the Centers for Medicare & Medicaid Services (CMS) includes new codes that apply when a physician remotely evaluates a patient via a telephone call or an image to determine whether the patient will require an office visit.

These new codes — categorized as “virtual check-in codes” — can be applied if the evaluation does not lead to an office visit and doesn’t occur within seven days of a prior evaluation and management service by the provider. The new codes also can be billed as a separate standalone service.

By definition, a virtual check-in is defined as a “brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified healthcare professional who can report evaluation and management (E/M) services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.”

As part of the Medicare Physician Fee Schedule, two HCPCS codes were added. They are:

HCPCS G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

It is important to remember this HCPCS code is only billable if the evaluation is performed by a provider qualified to furnish and bill for evaluation and management service.

HCPS G2012: Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified healthcare professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

This code requires direct interaction between the patient and the billing practitioner. Again, it’s important to remember this HCPCS code is billable only if the evaluation is performed by a provider qualified to furnish and bill for evaluation and management service.

Things to remember when utilizing these HCPCS codes:

• These codes can be used for established patients only. CPT defines an established patient as one who has received professional services from the physician or qualified healthcare professional or another physician or qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
• The physician must obtain and document patient consent. The consent is not a blanket consent. Consent must be obtained each time this type of service is requested.
• This is no frequency of use limitation for 2019.
• No service-specific documentation requirements have been published. Documentation for virtual check-ins is consistent with the requirements for other Medicare-covered physician services.
• The patient is responsible for a co-payment for this service.

Virtual check-in services are covered by CMS, as well as many other payers. Most payers find virtual check-ins attractive because they may save an office visit. However, you would need to check with each payer individually to see if these codes are covered.

Once policies and procedures are put in place to cover the requirements for utilizing these codes efficiently and effectively, this can — over time — represent a significant amount of money for a practice dependent on specialized services.

For more details about how virtual check-in codes can affect your healthcare practice, reach out to us at Kraft Healthcare Consulting.

© 2019

This article originally was published in the July 2019 edition of Nashville Medical News.