The ins and outs of telehealth coding

Medical coding is finicky in its own right, and when telehealth is added to the mix, the process becomes even more complex.

In order to be properly reimbursed, there are specific requirements that must be met for care provided via telehealth. 

Here is what anesthesiologists — and physicians in general — need to know about the rules and regulations of telehealth coding, according to an April 15 post by medical revenue cycle management group Coronis Health.

Medicare Part B pays for services that a physician or practitioner provides "via 2-way, interactive technology," according to a February 2024 Medicare Learning Network article cited by Coronis. Coronis notes that telehealth substitutes for an in-person visit and generally involves two-way, HIPAA-compliant audio-visual interactive technology that permits communication between the physician and patient; however, Section 4113 of the Consolidated Appropriations Act permits audio-only telehealth for some non-behavioral health services through December 31.

In 2023, physicians were required to report the place of service the patient would have been seen in if the visit was in person — for example, either at an office or a facility — with the 95 modifier, which indicated telehealth services. However, Medicare changed the requirements at the beginning of this year. 

For telehealth services, it is no longer necessary to report the place of services or to use the 95 modifier. Instead, claims must use one of two codes:

• POS 02: Telehealth provided in other than the patient's home.
• POS 10: Telehealth for services when a patient is in their home.

However, there is one exception: when the patient is in their home and the provider is in the hospital, in which case the hospital place of service code is used along with the 95 modifier, according to the group.

In review, there are four essential pieces of information that need to be documented for accurate telehealth coding:

1. The patient's agreement to a telehealth visit. 
2. The patient’s location during the visit.
3. The provider's location during the visit.
4. The platform being used, with indication of whether the visit was via audio-visual or audio only.