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  • ICU Telemedicine Billing

    I work for a small community hospital as pulmonary and critical care physician. I am the only routine onsite pulm/CC provider and the hospital is preparing for a lot of overflow and critically ill patients beyond normal (we may have 1-2 "true" critical care patients on an average day, and 25 patients is a very busy hospital census). As the only provider capable of taking care of patients that are even modestly ill at my facility, as well as to limit physician exposure the hospitalist is first to see patients, and any possible COVID cases I am doing telemedicine visits for the consult with video/audio and billing G0425-G0427 codes with the expanded telemedicine allowances per CMS.

    My question is if things really go hit the fan and we are seeing multiple critically ill COVID patients, what exactly is billable for inpatient telemedicine for critical ill patient. It is getting very confusing with all the CMS new allowances.

    Is 99291 (Critical care) billable remotely via telemedicine? How about 94002-94003 (vent management)? Am I stuck with the G0425-G0427 for new patients and the G0406–G0408 for follow up?

    It will likely be divide and conquer if staffing really gets this bad, but I will still be responsible for all critically ill patients. Hospital is considering keeping me off "direct contact" and limiting it to only those needing procedures since if I contract the virus they are completely without any critical care experience.

    Our hospital made urgent decision to establish with a telemedicine service that allows it to work with any web browser so makes this very easy to set up (And was active in less than 2 days).

    Appreciate any insights into how this can be billed, or suggestions of other codes, options to help manage what may be overwhelming critically ill patients while limiting contact would be appreciated. Thanks all, and stay healthy!

  • #2
    We’ve been using the codes G-0508-GT and G0509-GT for initially CCM consults and followups, respectively.

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    • #3
      Thank you, I didn’t realize these codes already existed. Anything special required in documentation other than time? And other than having audio/video any other requirements?

      at my facility this may also allow me to “take a day off” and virtually round on stable critical I’ll patients/manage vents etc on weekends/holiday in the future.
      Last edited by wildcat16; 03-27-2020, 04:48 PM.

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      • #4
        Originally posted by wildcat16 View Post
        Thank you, I didn’t realize these codes already existed. Anything special required in documentation other than time? And other than having audio/video any other requirements?

        at my facility this may also allow me to “take a day off” and virtually round on stable critical I’ll patients/manage vents etc on weekends/holiday in the future.
        I’ve been told you have to use a remote stethoscope for a pulmonary exam. I have no idea if this is true as I haven’t looked into it, but my medical director told us to do it so I do.

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        • #5
          I think some states require this for telemedicine in general, but I can't find any guidance specifically as it relates to tele ICU G0508 and G0509 codes. Technically 99291 and 99292 codes don't "require" physical exams and is time based only, however typically we will document at minimum pertinent findings. I have seen some mention of having a nurse listen to lungs/heart and relay this information back.

          What are the documentation requirements. Obviously would document reason for consult, requesting provider for consult, who was present in the room/on call such as family/other providers, which provider you relayed your information back to. For the G0508, do you just have to document >60 minutes time, or is this similar to chart review codes where it is an "average of 60 minutes, but only need to document >31 minutes)?

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