Telehealth in PALTC

COVID-19 and Telehealth Information:

 

  • Society Guidance for Submitting Clean Claims for Telehealth Services During COVID-19 in the Nursing Home Setting (UPDATED 04/09/2020 to reflect new COVID-19 Telehealth Waivers:
  1. Originating site (where the patient is located) is furnished in any emergency area during any portion of any emergency period
  2. The patient has been seen by the same or other qualified provider in the same practice (as determined by tax ID)
  3. Distal site consult is conducted by a qualified provider (physician or practitioner)
  4. Distal site provider billing and coding requirements:
    1. Use appropriate CPT E&M nursing facility code (99304-99310, 99315/16)
    2. Use appropriate Place of Service (POS) Code: 31 SNF; 32 NF
    3. Use modifier 95
    4. Conduct telehealth visits “as appropriate”
  5. ICD-10-CM Official COVID-19 Coding Guidelines
  1. Please note that you will generally need two codes to describe the scenario until October 1 when new codes will come out. 
    1. Pneumonia: Code for the PNA J12.89 then B97.29; other coronavirus as the cause of diseases classified elsewhere
    2. Acute Bronchitis: J20.8 Acute Bronchitis due to other specified organisms, and B97.29; other coronavirus as the cause of diseases classified elsewhere
    3. Lower respiratory infection (or acute respiratory infection): J22 unspecified acute lower respiratory infection, and B97.29; other coronavirus as the cause of diseases classified elsewhere
    4. ARDS: J80, Acute respiratory distress syndrome, and B97.29; other coronavirus as the cause of diseases classified elsewhere
    5. Concern about exposure to COVID-19 but determined to not have been exposed: Z03.818, encounter for observation for suspected exposure to other biological agents ruled out
    6. Actual exposure to someone with confirmed COVID-19: Z20.828, contact with and (suspected) exposure to other viral communicable diseases
  2. If the patient is not known to have COVID-19, and presents with cough, fever, or shortness of breath, just assign the code for that symptom:
    1. R05 Cough
    2. R06.02 Shortness of breath
    3. R50.9 Fever, unspecified
  3. ICD-10-CM Official Coding Guidelines

 


Below are some resources on telehealth in the PALTC setting:

CMS Telehealth Resources: