Hitting a Nerve

Reimbursement for telemedicine services: A billing code disaster


In December 1917, a large part of Halifax was destroyed when an ammunition ship exploded.

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

In the wake of the explosion large parts of the city were burning. Surrounding communities’ fire departments raced to the scene, only to find their efforts thwarted by a lack of uniform standards for hydrant-hose-nozzle connectors. With no way to tap into Halifax’s water supply, their hoses were worthless.

In the aftermath of WWI, this led to a standardization of fire hose connectors across multiple countries, to ensure it wouldn’t happen again. Sometimes it takes a disaster to bring such problems to the forefront so they can be fixed.

One issue that has come up repeatedly in talking to other physicians is the complete lack of uniformity in telemedicine billing codes. While not a new issue, the coronavirus pandemic has brought it into focus here, and it’s time to fix it.

Here’s an example of information I’ve found about telemedicine billing codes (Note: I have no idea if any of this is correct, so don’t rely on it in your own billing).

  • Aetna: Point of service 02
  • Cigna: Point of service 02 with modifier 95.
  • BCBS Anthem Point of Service 02 with modifier GT.
  • Medicare: Point of service 02 OR Point of service 11 with modifier 95 (I’ve seen conflicting reports).

And that’s just a sample. BCBS, for example, seems to vary by state and sub-network.

This is ridiculous. Even with different plans, the CPT and ICD10 codes are standardized, so why not things such as POS codes and modifiers? The only ones benefiting from this are insurance companies, who get to deny claims on grounds that they weren’t billed correctly.

This is, allegedly, the Internet age. Medical bills are submitted electronically, and often paid the same way. If such a complicated system can be made to work in so many other ways, it should be standardized to benefit all involved. Including those doing our best to care for patients in this challenging time – and at all times.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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