Waiving Medicare Cost-share for Telehealth Visits

Question:

I heard that Medicare patients don’t have to pay their deductible or coinsurance if they have a telemedicine visit. Is this true?

Answer:

Medicare is not waiving deductibles or co-insurance. However, they are allowing providers to do so at their discretion without penalty for telemedicine visits. This means the provider will only be reimbursed what Medicare pays, if the provider chooses to waive the patient portion of the visit. Many payors are waiving cost-sharing for telemedicine visits. See Payor Telehealth Policies for more information.

*This response is based on the best information available as of 03/10/22.

2021 E/M Guidelines MDM Table

Question:

We are using the 2021 E/M guidelines in the office and in most cases base the level of service on medical decision making.  If I have a patient with a chronic condition that is stable who also has diabetes in which the Internist (nor our specialty) is managing, can I assume the number and complexity of problems addressed is moderate since I have 2 diagnoses?

Answer:

If the physician is not managing the diabetes, it cannot be counted toward complexity of problems addressed. In this situation since the chronic condition is stable it equated to low for the element. Keep in mind you also have two other elements for medical decision making; amount of and/or complexity of data to be review and risk of complications and/or morbidity of patient management. Two of three elements must be met to support the level of medical decision making.

*This response is based on the best information available as of 02/24/22.

Use of a Scribe

Question:

We are hiring a scribe for the doctor because it will help improve his documentation.  Is there anything we need to know about how to document this?

Answer:

Yes, absolutely. This situation should be clearly delineated so a third-party reviewer can identify the provider who performed the service, and the record should be signed by both parties (the scribe and physician).

Remember, a scribe does not ask the patient any questions, nor does a scribe do an examination of the patient. A scribe merely records the information obtained by a provider. Bottom line is that a nurse practitioner or physician assistant generally does not act as a scribe.

Example of statements:

I, (scribe name), am serving as a scribe to document services personally performed by (physician name), based on my observation and the provider’s statements to me.

and

I, (physician name), attest that (scribe name) is acting in a scribe capacity, has observed my performance of the services, and has documented them in accordance with my direction.

*This response is based on the best information available as of 02/10/22.

Telehealth Licensure Requirements

Question:

We live in a northern state and frequently have patients who travel to warmer clients during the winter.  Are you able to directly me to information on state licensure requirements for Telehealth services?

Answer:

Yes, you will now find this list on the KZA Telehealth Solution sitehttps://karenzupko.com/KZA-telehealth-solution-center. Look for the tab that says, “Licensure Requirements –New”.

*This response is based on the best information available as of 01/27/22.

Fractional Laser Therapy

Question:

We are going to be doing laser therapy for hypertrophic burn scars.  From my understanding we will be using fractional ablative CO2 laser therapy.

Answer:

There are 2 category III codes to report this procedure, 0479T and 0480T. CPT code 0479T is reported for the first 100 cm2 or part thereof, or 1% of body surface area of infants and children and 0480T is the add-on code for each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof. These codes were added in 2018. If the payor does not accept Category III codes, you would report the unlisted code 17999 and submit documentation to the payor for reimbursement. It might be a good idea to check with your individual payors to see if this procedure is covered and if preauthorization is required.

*This response is based on the best information available as of 11/11/21.

Coding an Epidermal Inclusion Cyst

Question:

I excised an EIC lesion on the chest.  I coded this as D48.5 but my coder says this is the wrong diagnosis code.  What is the correct diagnosis code?

Answer:

ICD-10-CM code D48.5 (Neoplasm of uncertain behavior of skin) is incorrect as you have stated the patient has an EIC (epidermal inclusion cyst). You should report L72.0,(Epidermal cyst).

*This response is based on the best information available as of 4/1/21.