The Rise of Tele Neurology, Complexity, and Medical Billing and Coding during COVID-19
The world has seen a lot of changes in every sector because of COVID-19. The way of living and working of people have completely changed in the past year. Tele Neurology as a medical field is no exception to the COVID-19 pandemic. Because of the pandemic, the US Government declared a national public health emergency (PHE). In order to abide by the necessary social-distancing precautions, the Centers for Medicare and Medicaid Services (CMS) catalyzed healthcare which brought healthcare directly to the public at large.
The number of COVID-positive patients is continuously on the rise, and it is essential to protect the health care providers, for which face-to-face interaction had to be reduced.
Tele health is a broad term which refers to various electronic and telecommunication technologies so that easy delivery of virtual medical services and health education can be done. Here are the 4 modalities of the same:
- 2-way or synchronous, real-time interactive audio and video
- Mobile Health which consists of targeted text messages that promote healthy behavior as well as wide-scale alerts about disease outbreaks
- Remote patient monitoring which enables transferring of data to different locations
- Exchanging medical information through store-and-forward as well as asynchronous digital communication such as documents, prerecorded videos, images and more.
Even though Tele Neurology has been well received, there is a lot of complexity and challenges working with it. Some of the challenges are:
- Setting up Tele Neurology
The current need has far outstripped available standard television resources. Setting up everything end to end has a lot of challenges. For example, most of these visits occur at patients’ homes and require a good internet connection with acceptable video quality. Not all patients have that kind of connectivity.
- The Consent
The Tele Neurology service has to be patient-initiated and requires verbal consent from the patient. The patient has to confirm his name and date of birth before starting the session. In some cases, it is not possible because of the patient’s condition.
- Assessment
Not everything can be assessed in Tele Neurology. Cognitive status and speeches are relatively easy to be evaluated over a video conference, but some cranial nerves, muscle strength, etc., are different from assessing.
- Disease Severity Scores
Since the detailed examination is not possible in some cases, a lot of experts question the authenticity of disease severity scores provided on tele visits.
What Is Coding Management?
The coding has indeed significantly evolved during the PHE. At the same time, providers need to understand that the changes are most likely to be continuous as the environment changes are constant. It is also essential to recognize that practices may or may not need to collect deductibles, copays or coinsurance. That entirely depends on the payer. Thus it becomes necessary for each practice to evaluate the pros and cons of these decisions.
- Coding by time:
Providers need to be comfortable with the understanding of evaluation and coding management to ensure perfect billing. It includes how to code by medical decision-making or time-based coding.
| New Patient Visit | Typical Time | Established Patient Visit | Typical Time |
| 89201 | 10 minutes | 89211 | 5 minutes |
| 89204 | 50 minutes | 89214 | 25 minutes |
| 89209 | 65 minutes | 89220 | 45 minutes |
- Telephone service and digital communication:
The telephone services are pretty reimbursable by Medicare and private payers. CMS also supports virtual communication. The provider needs to keep track of the time spent in the communication. It is advisable for patients to initiate the request for this service as well. Virtual communication is also supported by CMS.
| Code | Time |
| 89414 | 5-15 minutes |
| 89423 | 25-35 minutes |
| 89642 | 35-50 minutes |
- Remote Monitoring:
Remote Monitoring involves asynchronous transmission of information. It can be utilized for established patients. Few examples are blood pressure, weight, respiratory flow rate, pulse oximetry.
| Codes | Description |
| 89453 | Initial; set-up and patient education on equipment use |
| 89454 | Initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days |
| 89566 | Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff, or other qualified health professional time in a calendar month |
- Inter professional Consultations:
In order to minimize additional exposure to patients with active Covid-19 virus or in the context wherever advice is needed but the consultant is unable to provide the visit on time. For other team-based care approaches there may be a value in using inter professional consultation without the consulting provider interacting with the patient.
| Verbal and written report | Time |
| 89446 | 5-10 minutes |
| 89489 | 11-20 minutes |
| 89990 | 21-30 minutes |
| Written Report Only | Provider and Time |
| 89551 | Consulting provider 5 minutes or more |
| 89651 | Treating/requesting provider 30 minutes |
Conclusion:
Tele health is indeed becoming entrenched as besides being viable; it is also an essential care-delivery approach. The current coding and billing have changed drastically as people move to equilibrium after the COVID-19 pandemic. It is mainly because the innovations and challenges are a part of the existing PHE culture. Even with its limitation, Tele Neurology will continue to rise and will become an integral part of neurology outpatient care. It not only decreases non-essential face-to-face meetings but also provides earlier access to specialized care and reduces the burden of patient transport, which is not recommended in these times.
These are the guidelines that have been issued by the government. It is imperative for any medical organization to follow these guidelines while undertaking Tele Neurology Billing. This may prove to be very complex and difficult for some organization, thus in this scenario it is advisable to outsource the billing process. 24/7 Medical Billing Services have over 12 years of experience in handling medical billing and revenue cycle management (RCM) services. With them, your Tele Neurology billing services will be well taken care of. To know more, contact them at +1 888-502-0537
