Billing Tips for Internal Medicine Telehealth Billing and Coding
Telehealth has become indispensable for internal medicine practices, enabling providers to manage chronic conditions, conduct preventive care, and streamline follow-ups. However, billing and coding complexities can lead to denials or underpayment. Below are 10 optimized billing tips tailored for internal medicine providers to maximize reimbursement and compliance in 2024.
Focus on Chronic Care Management (CCM) and Annual Wellness Visits
Internal medicine thrives on managing chronic conditions (e.g., diabetes, hypertension) and preventive care. Use these codes:
- CCM Services: 99490 (20+ minutes/month) or 99439 (additional 20 minutes).
- Annual Wellness Visits (AWV): G0438-G0439 for Medicare patients.
- Prolonged Services: G0318 (beyond E/M visit time) for complex cases.
Why it matters: These codes are high-value for internal medicine and are often underutilized in telehealth.
1.Internal Medicine-Specific CPT Codes and Modifiers
Avoid denials with specialty-focused coding:
- E/M Visits: 99202-99215 (office/outpatient) + modifier 95 (telehealth).
- Chronic Disease Education: 98960-98962 for diabetes or hypertension self-management.
- Modifier 25: Use when a significant, separate service (e.g., smoking cessation counseling) is provided during a telehealth visit.
Example: A 30-minute video visit for a COPD exacerbation (99213 + modifier 95) + 99407 (15+ minutes tobacco counseling) + modifier 25.
2.Master Medicare Billing for Older Adults
Internal medicine heavily serves Medicare patients. Key updates:
- No Geographic Restrictions: Temporary waiver extended through 2024—bill POS 02 even if the patient is at home.
- Audio-Only Visits: Use 99441-99443 (phone) or modifier 93 for Medicare.
- RPM (Remote Patient Monitoring): 99453-99457 for tracking chronic conditions like CHF.
Tip: Pair RPM with CCM codes to boost reimbursement for longitudinal care.
3.Document Complexity to Justify Higher-Level E/M Codes
Internal medicine visits often involve multiple comorbidities. Document:
- Number and severity of chronic conditions addressed.
- Medication reconciliation (e.g., adjusting insulin doses).
- Time spent coordinating care with specialists.
Sample Note: “45-minute video visit: Reviewed 7 chronic conditions, adjusted antihypertensive regimen, and coordinated with a cardiologist. Time spent: 35 minutes (face-to-face).”
4.Verify Insurance for Hybrid Care Models
Many internal medicine practices blend in-person and telehealth care. Confirm:
- Private Payers: Some restrict telehealth for follow-ups (e.g., UnitedHealth care).
- Medicaid: State-specific rules (e.g., California covers RPM for Medicaid).
- Commercial Plans: Prior authorization requirements for virtual AWV.
Tool: Use Expressmbs eligibility checker for real-time Medicare/Medicaid updates
5.Optimize Coding for Rural and Underserved Patients
Internal medicine providers in rural areas can leverage:
- Originating Site Fee (G2025): Billable by RHCs/FQHCs for facilitating telehealth.
- HCPCS G0071: Virtual care management for Medicare patients in Health Professional Shortage Areas (HPSAs).
Case Study: Use G0071 + G0318 for a 60-minute telehealth visit managing diabetes + CKD in a rural patient.
6.Use EHR-Integrated Telehealth Platforms
Streamline workflows with tools that sync with internal medicine EHRs (e.g., Epic, Cerner):
- Auto-populate visit details into progress notes.
- Embed coding prompts for chronic care (e.g., “Document time spent on CCM”).
- Ensure HIPAA compliance with BAAs for vendors like Zoom for Healthcare.
7.Train Staff on Internal Medicine-Specific Audits
Audit risks for internists include upcoding E/M visits or missing CCM documentation.
- Internal Audits: Review 10% of charts monthly for time-based code accuracy.
- External Prep: Ensure consent forms and technology logs are archived.
Red Flag: Mismatched time documentation (e.g., billing 99214 for a 15-minute visit).
8.Educate Patients on Telehealth Cost-Sharing
Internal medicine patients often have multiple visits. Clarify:
- Medicare: No copay for AWV or CCM, but 20% coinsurance for E/M visits.
- Private Insurers: Copays for video vs. audio-only (e.g., Aetna waives copays for video).
Script: Your telehealth visit for hypertension follow-up may have$20 a copay confirmed with your insurer.
9.Stay Ahead of 2024 Coding Changes
Bookmark these updates critical to internal medicine:
- New SDOH Codes: Z55-Z65 for documenting social determinants impacting chronic diseases.
- G2211: New E/M add-on code for complex care (effective Jan 2024).
Resource: Subscribe to the AMA’s Internal Medicine Coding Alert.
Final Thoughts
For internal medicine practices, telehealth billing success hinges on chronic care expertise, Medicare compliance, and meticulous documentation. By aligning coding with your specialty’s workflows, you can secure rightful reimbursement and sustain patient access to virtual care.
Need Internal Medicine-Specific Support? Explore Expressmbs for Medicare billing guides, audit templates, and coding webinars and coding.
