It’s important for medical coders to understand the differences between audio-only visits and telephone visits, as they are not the same, despite both being types of telehealth services.
- Key Differences in the Codes:
- Audio-only codes are designed for both new and established patients. This means that these codes can be used whether it’s the first time a patient is seeing the provider or if they’ve been seen before.
- Telephone codes, on the other hand, are only for established patients. These codes cannot be used for new patient encounters.
- Who Initiates the Visit?
- Telephone visits can only be initiated by the patient. This means the patient must be the one to contact the healthcare provider to set up a telephone consultation.
- Audio-only visits, however, can be initiated by either the physician or another healthcare provider. This gives providers more flexibility in initiating the interaction.
- Time Limits:
- Telephone visits have a time cap. This means there is a limit to how long a telephone consultation can last.
- Audio-only visits do not have a time cap. In fact, there are extended service codes available for longer audio-only consultations, allowing for more flexibility in the duration of the visit.
- Purpose of the Visit:
- Both audio-only and audio-video telehealth services are used for synchronous, real-time interactions between a physician and a patient. The key here is that these interactions must involve medical discussion.
- These services are not for routine communications related to previous encounters. For example, a quick call to a patient saying “Your lab results look good. Keep up the good work” is not appropriate for these services. The services must involve distinct and medically necessary discussions, such as discussing new symptoms, treatment plans, or follow-up care.
- New Codes for 2025:
- Synchronous audio-video codes: These are the codes used for telehealth visits that include both audio and video (real-time video consultations). The codes are 98000-98007.
- Synchronous audio-only codes: These are used for telehealth visits that only involve audio, with no video. The codes are 98008-98015.
- Brief synchronous communication technology service: This is a new code for short, real-time communications that are 5 to 10 minutes long. This discussion cannot be related to a previous E/M service in the past 7 days, nor should it be leading to an E/M service in the next 24 hours. The code for this service is 98016.
- The 98016 code replaces the older CMS virtual check-in service, which previously used the code G2012 under the Healthcare Common Procedure Coding System (HCPCS).
Summary for Coders:
- Remember that audio-only codes can be used for both new and established patients, whereas telephone codes are only for established patients.
- Audio-only visits can be initiated by healthcare providers, while telephone visits can only be initiated by patients.
- Audio-only visits have no time cap, unlike telephone visits, and longer consultations can be billed with extended service codes.
- Both types of visits must include medical discussions and should not be used for routine communications.
- The 98016 code replaces the G2012 code for virtual check-ins, and new codes are introduced for both audio-video and audio-only visits in 2025.
By understanding these differences, coders can accurately assign the correct codes for telehealth services, ensuring proper billing and compliance.