Telehealth for Pediatrics

Welcome to the Georgia AAP Committee on Telehealth Resource Hub

The Chapter’s Committee on Telehealth seeks to advocate for and provide resources to support telehealth services for Georgia’s children and their families. To that end we wish to receive your questions, comments, and concerns with regards to the access and delivery of telehealth services.  Any questions with regards to delivering of or reimbursement for telehealth services will be shared with the Committee members for response. Please allow 72 hours for a reply. Also please be sure to review previous posts of telehealth FAQs as your question may have already been posed to the committee for a response.  Lastly, please be sure to review our resource section for additional information.

Telehealth FAQs

The following questions have been previously posed to the Committee for review and response.

Are we able to do a telemedicine appointment if the family has traveled out of state but child becomes ill?

Yes, these restrictions have been lifted during the public health emergency.

Are we able to do a telemedicine appointment if the child and parent are not in the state of Georgia?

Yes, during COVID, many states have waived the requirement and are allowing telehealth if you have a valid license in at least one state. Click here for more.

Can a physician take call from their home?

Yes,  restrictions have been lifted during the public health emergency.

 

Is it necessary to add start and stop times of you bill based on MDM?

Yes, one of the requirements for any telehealth visit is to document a start and stop time regardless of medical decision making (MDM). You can use the following template to prompt you to document correctly (cut and paste to your EMR)

Telehealth Visit HPI

VERBAL Consent to conduct the visit via telehealth was obtained.

Name of person(s) on phone:
Role/Relation: parent(s)
Start time:
End time:
Total time*:

*If using time to determine level of service do not forget to include a time statement [>50% of (insert total time) minute visit was spent in face to face discussion about [condition]…)

COVID-19 Screening: patient/parent reports no travel or known exposure to COVID-19 in the past 7 days, no fever, no SOB, no cough, no nausea, or vomiting

 

 

How often do you need to obtain telemedicine consent? Once per year?

Yes, written once per year but verbal with each encounter. Must verify that they understand this counts as an encounter to which copays and deductibles will apply.

 

Can consent be obtained by email stating that consent will be presumed for telemedicine services unless notification is received by practice that consent is denied?

In other words, consent is presumed unless withdrawn by active notification by patient to the office.   Verbal consent is acceptable during the public health emergency.

 

Can you bill for a telemedicine visit if you decide during the visit that they need to be seen in person?

You can bill for either the telehealth visit or the in person visit if they come in that same day.

 

If you do a televisit and then the very next day the child must come into the office for the same chief complaint, does that void the televisit?

No. If there was an in-person visit 7 days before or within 24 hours after for the same type of problem you cannot bill for the telehealth visit.

To establish clear symptoms for flu diagnosis, you need to do a visit of some sort. This seems like pushing low quality care at some point. We need to be careful that this does not swing the other way. Telemedicine should not be low quality care. Why do we want to make it that way? Telemedicine is what you make it. If you see the child and you have concerns, end the visit and have them come into the office or refer them to the appropriate place if you are closed.

 

Can you add 99051 if you do telemedicine after your usual business hours?

No.

 

Could you extrapolate a face to face visit to a Telemedicine visit in terms of using the 99214 code? Or it must be the 99213 all the time?

Recommend basing visits on MDM, not time. ADHD visits with problems with sleep, allergies etc.,  become a 99214. Document at least 5 systems in your physical exam. One item from each system counts as that system being addressed.  However, remember that only 2 of 3 are needed for established patients and therefore, the exam may not need to be counted. If you can get a detailed history and MDM of moderate complexity, you may report a 99214.

 

What are your thoughts on how long insurers are willing to provide parity for telehealth care visits when incidence of COVID-19 cases begin to improve?

The earliest expiration dates are May 31st, some are June 30th and Medicaid has not put an expiration date yet. Most will track the length of the federal Public Health Emergency, which is to end in July, unless extended.

Do you have any resources for teaching parents how to check respiratory rate, or links to what a barking cough sounds like, etc.?

Our next telehealth webinar 201 should cover apps and resources to assist with this.

 

If your usual telemedicine vehicle (ours is AmWell) has a technical failure, is it acceptable to continue on FaceTime if possible, and if so, can you bill it as a telemedicine visit or does it become a phone visit for billing purposes?

Non-HIPAA compliant technology is temporarily allowed during the public health emergency. However, you must document that you informed the patient it may not be secure and obtained their consent to use that platform.

 

Is there a code for chart and record review without face to face contact with patient in preparation for a telemedicine visit? thank you.

 If you spend 30 minutes or more, you may look to the non-direct prolonged services codes (99358-99359).

Time: often face to face can be relatively quick if try to keep eye contact during telemed visit and visit. After visit, it takes time to document in EHR. Can you add this to visit time when billing?      No.  However, as of Jan 1, 2021 the time codes for E/M visits changes and plans may have adopted the more relaxed definitions already. Be sure to get the change of policy in writing.  Click here for more.

It is not the documentation time to bill for, it is the chart review and lab and report review before placing the telemedicine communication. Is there a code for preparation for the telemed contact?  If you spend 30 minutes or more, you may look to the non-direct prolonged services codes (99358-99359).

 

How do you do a medically necessarily follow up if the patient must initiate the visit?!?

Catch-22!! The  intent of the rule appears to note that you are offering telehealth as an option, but not the only way to access care. The patient cannot be forced to do a telehealth visit. A service that needs to be patient initiated is telephone care (99441-99443) and online digital E/M service (e.g. portal). Telemedicine which can be reported with 99212-99215 does not have to be patient initiated.

 

For an audio only visit, do we bill the same E&M codes as with audio/video visits?

For GA Medicaid FFS & CMOs the answer is yes. For commercial insurance, the answer is no. Audio only should be 99441-99443 based on total time. (Phone codes require total time only not start and stop times)

Is there a max code that we must use?

Everything is based on your documentation and MDM

 

Is there a max code you can use? Can we use a 99215 if visit was longer or more complex?

Yes – same as face to face, report the E/M code that supports the level of care or time. You may even use prolonged services (99354-99355)

Are we able to bill a 99215 in a telehealth visit?

          If medically necessary and supported with your documentation.

Disclaimer:  The contents of this resource are for general informational purposes only.  While every effort has been made to ensure its accuracy, the information is provided “as is” and no representations are made that the content is error-free.  The information is not intended to constitute legal advice or replace the advice of a paid qualified professional practice management consultant or attorney.

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American Academy of Pediatrics Georgia Chapter