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  • Medicare Coding Resources
    Medicare Utilization Data for Infectious Diseases Specialists

    Listed below are common CPT codes used by ID Specialist and the frequency with which they were used.

    Please visit Medicare’s Research, Statistics, Data & Systems Page for additional free and purchasable information, including utilization rates, cost reports, error rates, and beneficiary and provider surveys. 


    2012 Medicare Utilization Rates for Relevant CPT Codes Used by ID Specialists
    Compared to Internal Medicine and other Relevant Medical Specialties

    Medicare Utilization Data 1996-2009: Infectious Diseases (PDF) 

    Descriptor of AMA CPT/RUC Process
    The American Medical Association (AMA) is responsible for the development and maintenance of the CPT® code set. CPT codes are used on insurance claims to report the services and procedures performed by physicians and other healthcare providers. The use of CPT codes provides a uniform means by which all stakeholders in healthcare are able to communicate to about the services provided to patients. The AMA is also responsible for the valuation of CPT codes. The AMA Relative Value Update Committee (RUC) develops relative values units for CPT codes. The relative values are used to determine a payment amount for healthcare services and procedures. The AMA RUC also provides those RVUs to the Centers for Medicare & Medicaid Services (CMS) which CMS may then use to set payment amounts for CPT codes when paid under the Medicare Physician Fee Schedule. For more information about the CPT code process visit the AMA website. More information about the AMA RUC Committee is available here.
    Ask the Coder
    Ask the Coder provides assistance to IDSA members for medical coding issues.
  • The ID Consult

  • E/M Valuation

    Evaluation & Management Coding Resources

    IDSA has developed Evaluation and Management (E&M) coding resources specific to the practice of infectious diseases (ID). Given that ID physicians provide more of these services than almost any other specialty, understanding the E&M coding rules will help to maximize payments and minimize audit risk. Please click on the hyperlinks below for more information about these resources.

    Non-Face-to-Face Prolonged Services

    Beginning January 1, 2017, the Centers for Medicare & Medicaid (CMS) will provide payment for non-face-to-face prolonged services reported by CPT® codes 99358 and +99359 (Prolonged evaluation and management service before and/or after direct patient care; first hour, and each additional 30 minutes). Previously, the work associated with these codes was considered to be included in work for face-to-face evaluation and management (E&M) services. Information on the codes and the time requirements may be found here.

    Additional E&M Coding Resources

    1995 Documentation Guidelines for Evaluation and Management Services (PDF)
    This guide provides information regarding medical record documentation, evaluation and management billing and coding considerations.

    1997 Documentation Guidelines for Evaluation and Management Services (PDF)
    This guide provides information regarding medical record documentation, evaluation and management billing and coding considerations. 

    Key Resources
     
  • Telehealth

    Health Information Technology (HIT) is the generation and transmission of digital health data. Within HIT, Telehealth is the use of remote health care technology to deliver clinical services and is becoming increasingly vital to our health care delivery system, enabling health care providers to connect with patients and consulting practitioners across vast distances and/or in a timely manner. Health care systems are embracing the use of telehealth technologies because they offer benefits such as virtual consultations with distant specialists, the ability to perform high-tech monitoring without requiring patients to leave their homes, and less expensive and more convenient care options for patients. Telehealth has moved into the mainstream and IDSA is working to provide members with resources to assist in understanding and adopting telehealth technology into the clinical practice of infectious diseases.

  • Telemedicine: The Basics

    The Infectious Diseases Society of America (IDSA) supports the use of telehealth and telemedicine technologies that allow for high quality, cost effective care.

    The IDSA has developed a position paper on the use of telemedicine and telehealth that outlines the various uses of telemedicine and telehealth and provides background material for ID physicians and their staff. IDSA Position Statement on Telehealth

    The terms telehealth and telemedicine are often used interchangeably, but the two terms have quite different meanings. Telehealth has been defined by the Health Resources Services Administration (HRSA) as use of electronic information and electronic communications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include the use of video-conferencing, the internet, store-and-forward imaging as well as streaming media and other forms of electronic communications.

    Telemedicine, on the other hand is described as the provision of patient care to a patient that is separated from the healthcare provider by a considerable distance. Technologies used in the provision of telemedicine may include a simple telephone call or the use of sophisticated video-conferencing equipment. Telemedicine may also involve the use of mobile health technologies such as wearable devices to track medication compliance and to monitor disease progression.

    There are three variations of telemedicine each of which have a distinct role in patient care.

    • Synchronous telemedicine: The provision of real-time, direct patient care using audiovisual technology. This type of telemedicine may be a substitute for in-person care. Synchronous telemedicine may be used to diagnose a disease, provide treatment, or render a consultative service like those that are provided by an infectious disease physician.
    • Asynchronous telemedicine: Is the use of store-and-forward technology (this is not direct patient care) whereby there is transmission of patient data to another healthcare provider or entity. Patient data may include items such as digital x-rays, MRIs or photos as well as the transmission of diagnostic test results and other recordable patient data. The transmitted data may then be used by other healthcare practitioners to provide patient care or provide an opinion. Infectious disease physicians may use asynchronous telemedicine to provide a consultation to other healthcare providers regarding the care of patient with an infectious disease. 
    • Remote patient monitoring: Is the use of patient monitoring devices such as those used to monitoring patient heart rhythms or monitoring medication adherence whereby the data is collected and subsequently transmitted back to the healthcare provider for use in medical decision making and patient care.


    The Telehealth Resource Center, funded by the Department of Health and Human Services and HRSA provides resources and education for providers who are presently providing telehealth services as well as those providers who wish to begin the provision of telehealth services. Click the link Telehealth Resource Center for additional resources and information on EHR.

    Key Resources

     
    Telemedicine Consults and Payment: The How-To's

    Basic Technical Requirements of a Telemedicine Consult:

    • Synchronous telemedicine visits should utilize a high-resolution video camera coupled with broadband technologies.
    • Connection speed of at least 384 kbps in both the downlink and uplink directions is recommended.
    • Videoconferencing systems must use HIPAA-compliant encryption software. HIPAA requires 128-bit encryption and password-level authentication.

    The American Medical Association (AMA) has prepared information on telemedicine with "how-to" guides to start a telemedicine program in your practice.



    Payment for Telemedicine:

    Medicare: The Centers for Medicare & Medicaid (CMS) reimburses for only a limited set of services that may subsequently be reported as telehealth services. When a service is provided and has been designated by the CMS as payable under Part B of the Medicare program, the modifier GT must be appended to the code on the claim. GT indicates to the claims processors that the service was provided “via interactive audio and video telecommunications systems” and the claim is paid according to Medicare’s established guidelines and payment policies.

    In addition to the use of the GT modifier on the claim, there are other requirements for the provision and subsequent reimbursement for telehealth services under the Medicare program. The telehealth service must be provided to the beneficiary located at a Medicare approved, originating site. An originating site is the location of the beneficiary at the time the telehealth service is rendered and for Medicare reimbursement purposes must be located in a rural location as defined by the following two geographical conditions:

     

    • A rural Health Professional Shortage Area (HPSA) located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract; or
    • A county outside of an MSA.


    The originating site (location of the beneficiary) must then be in a medical facility such as:

    • Physician or other practitioner office
    • Hospital
    • Critical Access Hospital (CAH)
    • Rural Health Clinic
    • Federally Qualified Health Center
    • Hospital-based or CAH-based Renal Dialysis Center (including satellites
    • Skilled Nursing Facility
    • Community Mental Health Center


    The beneficiary’s home is not an approved originating site for the provision of telehealth services.

    Medicare Telehealth Approved Codes of Interest to Infectious Disease Physicians,

    • Office or other outpatient visits: CPT codes 99201-99215 
    • Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days: CPT codes 99231-99233
    • Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days: CPT codes 99307-99310
    • Telehealth Pharmacologic Management: HCPCS code G0459
    • Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour: CPT code 99354
    • Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes: CPT code 99355
    • Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient evaluation and management service): CPT code 99356
    • Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service): CPT code 99357


    List of all Medicare approved telehealth services may be found on the CMS website: Medicare List of Telehealth Services

    Medicare Payment for Telehealth Services: Changes on the Horizon:
    Recently introduced Senate legislation, if passed, would eliminate or lessen the restrictions that are currently in place for Medicare reimbursement for telehealth services. The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act would provide for additional approved originating sites including telestroke evaluation and management sites, Native American health service facilities as well as some dialysis facilities.

    The bill would also allow the use of telehealth and remote patient monitoring for those providers that would participate in alternative payment models, patient-centered medical homes, and payment bundling programs, without the current regulatory restrictions to telehealth services. In essence, the bill would remove many of the requirements such as originating site requirements and types of locations that are permissible as originating geographical locations. A brief description of the bill’s provisions and the list of endorsers can be found here: CONNECT for Health Act

    CMS Waives Certain Restrictions for Telehealth Services Under New Payment Model
    Another change to telehealth services is the recently implemented Medicare Comprehensive Care Joint Replacement Payment Model. While it may seem that this Medicare payment model has very little to do with telehealth, this model in fact has waived the requirements of the originating site location and the geographic location of the patient. Under this payment model, patients may be located in their homes and may be located in any geographic location and still be allowed to receive a telehealth service. All other requirements for the provision of telehealth services remain as is. An educational article is available here: CMS CCJR Payment Model and Telehealth Services


    Medicaid:
    While there are restrictions on reimbursement for telehealth services under the Medicare program, many states provide reimbursement for telehealth services under state Medicaid programs. States have discretion as to how telehealth services will be reimbursed and therefore many states currently provide separate payment for telehealth services under state Medicaid programs. Presently, 49 states and the District of Columbia provide some coverage for telehealth services, while nine states including Alaska, Arizona, California, Illinois, Minnesota, New Mexico, Oklahoma and Virginia reimburse providers for the provision of store and forward services. In addition, there are 17 states that have some form of reimbursement for remote patient monitoring. Providers should check with their state Medicaid agencies to understand the requirements and restrictions of Medicaid payments in their respective state.

    Commercial/Private Payers:
    Commercial insurance companies may set their own policies regarding coverage and reimbursement for telehealth services, however there are some states that mandate coverage for telehealth services in order to do business within that state. At this time, there are 32 states and the District of Columbia that have telehealth private payer laws. Providers should check with each insurance carrier to determine what types of telehealth services are covered.

    The National Conference of State Legislatures recently released a white paper detailing trends in telehealth policies (including the states the cover telehealth services) as well as outlining the considerations that providers must think about before implementing telehealth policies. The paper can be accessed here: Telehealth Policy Trends and Considerations

    Telehealth Presentations from IDWeek 2016

    A symposium on telehealth from IDWeek 2016 included the following presentations:

    • "Necessary Components for Telehealth: ECHO Telementoring and Other Strategies to Increase Workforce Capacity" (Brian Wood, MD)
    • "How to Negotiate a Contract to Offer Telehealth" (Javeed Siddiqui, MD, MPH)
    • "Technology beyond Telehealth: How Mobile Health Devices will Change the Practice of Medicine and ID" (David Classen, MD, MS)

    Videos of the three presentations and information about the symposium can be found on the IDWeek website.

    Tele-Antimicrobial Stewardship Video
    This video about IDSA's tele-antimicrobial stewardship (T-AS) resources provides an overview of telemedicine as it applies to antimicrobial stewardship activities. Included in the video are a brief demonstration of a T-AS session; an overview of credentialing; technology requirements for telemedicine; and testimonials from health care professionals who employ telemedicine and T-AS and why they like these platforms.
    mHealth
    The use of mobile technology in providing healthcare is on the rise. Devices such as mobile phones, personal digital assistants (PDAs), smart tablets, patient monitoring devices, and other wireless devices, are now being used by providers and patients as a part of the overall healthcare plan for a patient. By using mobile devices physicians are able to interact with other healthcare providers as well as patients to provide consultations, diagnosis problems and monitor the health of a patient.

    The Healthcare Information and Management Systems Society (HIMSS) has developed a roadmap that may be a useful resource for ID physicians and their staff. The roadmap provides information and guidance for those physicians and hospitals that wish to adopt mHealth technologies in the delivery of patient care. The roadmap includes topics such as the development of new care models using mHealth technology, the policy matters, privacy concerns and security needed to adopt mHealth technology. In addition, the roadmap outlines information on return on investment and payment considerations as well as the standards and interoperability required to use mHealth. The roadmap can be accessed here: HIMSS mHealth Roadmap

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