Be it any medical practice offering telehealth; one must adhere to the ICD 10 codes. There is no option for doctors, hospitals, or medical service providers to neglect such codes. In fact, they need to incorporate the telehealth strategy into their practice to stay in the competitive medical business.

However, there are also some challenges that telehealth facilitators are facing. It is because telehealth is a broad category and encompasses managing a wide range of complex situations. It ranges from remote monitoring of stroke patients to high-quality virtual convenience care and managing episodic, acute, and sometimes non-emergent conditions in fast, effective, and cost-efficient ways.

In such a scenario where the medical landscape of care is expanding worldwide, telehealth billing and coding must also be prioritized. Therefore, telehealth medical providers need to adhere to three core principles:

• Implementation of the established care standards.
• Ensuring insurance coverage.
• Cross verification of the patient information.

The other vital aspect of telehealth billing and coding is understanding the ICD 10 codes and accurately implementing them as per the telehealth service provided.

What are the ICD 10 Codes in Telehealth?

International Classification of Diseases (ICD) codes are a set of designations used by healthcare providers to communicate diseases, symptoms, and findings of a patient’s diagnosis. ICD 10 codes are used to establish the medical necessity of the telehealth services to insurance providers for claiming the complete reimbursement.

While telehealth ICD 10 codes often appear on patient paperwork and bills, there are often instances when the codes are miswritten. The onus is on the telehealth service providers to ensure the correct codes are entered while necessary verbal or written consent is taken from the patient for any virtual consultation.

It must be remembered that the ICD 10 codes for telephone consultation differ from those used for video consultation and medical facility visits for the same condition suffered by the patients. 

Top 3 ICD 10 Codes for Telehealth

The release of the ICD 10 codes has now become a one-off manifesto for every healthcare professional and physician for recording and maintaining standardized clinical data, documentation, claims to process, and public health reports.

However, ICD 10 has many codes, and telehealth providers must be careful in identifying the correct code and entering it accordingly to ensure proper reimbursement of the claim. There are four primary areas that the telehealth coders must be aware of while implementing the codes:

• Place of Service (POS)
• Modifiers
• Cost-Share Waiver
• Cost-Share Coverage

Let’s have a look at the ICD 10 codes to be used for telehealth:

Evaluation Management Services on Telephone

The codes for E/M (Evaluation Management) services for telephone or audio-only has a different set of guidelines in ICD 10. In fact, the patient cannot be a part of a related E/M service that has originated in the last seven days or led to the same service in the next one day. The patient needs to be coded based on the duration of the E/M service or medical discussions as follows:

1. 5 – 10 mins – Code 99441
2. 11 – 20 mins – Code 99442
3. 21 – 30 mins – Code 99443

Patients Monitored Remotely

The ICD 10 codes have also been valued by Medicare, where established and new patients can avail of remote monitoring for chronic, acute, and single disease conditions. A range of codes used under this category include:

• 99091 for interpretation and collection of physiological data.
• 99453 for educating the patient and set-up up the monitoring equipment.

There are five more codes under this category.

Emergency Department Telehealth Services

Under this category, dozens of codes range from 99217 for discharge services for observation care to G0406 – G0408, where telehealth consultation for inpatient follow-up is done in SNFs or hospitals.

It is vital to note that in telehealth Emergency Department services, the coding needs to be done for inpatient and observation. Also, a Modifier 95 is to be attached for commercial payers, and the Medicare telehealth billing may use it for an interim purpose.

Why Adhering to ICD 10 in Telehealth Billing is Important?

It is a known fact that when there is any incorrect coding in a bill, the reimbursement from the insurance companies will be either rejected or denied, which means there is a loss of revenue. With telehealth becoming a predominant way to get healthcare services for many, the ICD 10 codes must be adhered to to ensure that medical practices and practitioners get remuneration for their services.

But with new HIPPA codes, about 70,000 ICD 10 codes, and ever-changing health regulation policies and software, keeping up with them can be challenging for any practice. In such a scenario, Info Hub Consultancy Services (ICS) can help with the telehealth coding and billing process and ensure no revenue loss due to rejected claims. Contact their experts right now and understand the process regarding where to begin.

Related Blogs

Medicare Telehealth Rules Are Changing—Here’s What Providers Need to Know

Medicare telehealth rules are undergoing a significant transition, and 2025 is the year providers must remain vigilant. The temporary flexibilities Read more

What’s New in ICD-10-CM and ICD-10-PCS? A Must-Read for Coders and Providers

Did you know that ICD-10 codes change every year and have a direct impact on hospitals, coders, and providers? ICD-10-CM Read more

Stop Leaving Money on the Table: How Offshore RCM Boosts Your Collection Rate

Every day, healthcare providers face increasing financial pressures. In fact, rising costs, stricter reimbursement policies and complex payer rules make Read more