Introduction of ICD codes
As a private practitioner, you must know the significance of providing precise and effective patient care. The proper documentation and coding of your services are crucial to achieving this. This is where ICD and CPT codes play a pivotal role.
These codes assist in relaying significant information about your patients’ diagnoses, treatments, and procedures to insurance companies, government agencies, and other healthcare providers.
By utilizing the appropriate codes, you can ensure that your claims are processed accurately, swiftly, and suitably reimbursed for your rendered telemedicine services.
This comprehensive guide will cover everything you need to know about ICD and CPT codes, including their differences and a list of all important ICD and CPT codes for telemedicine.
Overview of ICD Codes
The acronym ICD stands for International Classification of Diseases, and the revision number that follows it, such as ICD-9, ICD-10, or ICD-11, specifies its version. This is a universal standard and global resource for collecting, organizing, and categorizing information regarding deaths and illnesses. This standardized method of managing healthcare data enables medical professionals and healthcare administrators to:
Healthcare information can be easily stored, retrieved, and analyzed for evidence-based decision-making.
Information can be compared and shared across regions, hospitals, and settings using a common language.
- Health information in the same locations can be compared across different time periods.
- Safety and quality guidelines can be tracked.
- Reimbursements and resource allocation trends can be observed.
- There is a classification standard for all research and clinical purposes.
- Deaths, injuries, diseases, symptoms, and reasons for encounters can be tracked.
- Factors influencing health status and external causes of diseases can be monitored.
- The incidence and prevalence of diseases can be observed.
According to the CDC, the guidelines for ICD-10-CM use have been approved by cooperating parties, including The American Hospital Association, the American Health Information Management Association, NCHS, and CMS. The guidelines are as follows:
- Conformity to the guidelines for assigning diagnosis codes is mandatory under HIPAA.
- HIPAA has implemented the diagnosis codes for ICD-10-CM in all healthcare settings.
- Report diagnoses using the maximum number of characters.
- Use the appropriate codes to indicate symptoms, diagnoses, conditions, complaints, or reason(s) for the visit or encounter.
- Signs and symptoms are considered acceptable if a diagnosis is not yet determined or verified by the physician.
- The symptoms and signs commonly associated with a specific disease should not be coded unless the classification states otherwise. The symptoms and signs that aren’t routinely connected with a particular disease must be coded.
- Multiple codes can be used to describe a single situation, for example, Code First, Follow Use Additional, and Code, when applied to all typical factors.
- If subentries exist for chronic and acute conditions, code both and place the acute condition first.
- Combination Codes – a single code used to distinguish two diagnoses, a single diagnosis with secondary manifestation, a process, or a diagnosis with a related complication.
Why the Need to Transition to ICD-11?
Unfortunately, even with yearly updates, ICD-10 has become outdated and requires significant structural changes in certain chapters. More detailed records for morbidity cases are necessary in today’s electronic environment.
ICD is the worldwide standard for recording, reporting, analysing, interpreting, and comparing morbidity and mortality information. WHO’s 11th revision of ICD was developed through close collaboration with clinicians, statisticians, coders, epidemiologists, and IT experts from around the world. It’s a rigorously researched standard that accurately captures current medical and health practices and represents a significant improvement from previous revisions.
Understanding CPT Codes
Medical professionals use CPT codes, five-digit codes developed and maintained by the American Medical Association (AMA), to describe the medical procedures and services they provide. These codes are recognized by insurance companies, Medicare, and Medicaid, and they help prevent fraud and abuse in the healthcare industry.
CPT codes are crucial for private practitioners as they provide a standardized language for describing medical procedures and services, ensuring accurate compensation for healthcare providers. There are three categories of CPT codes: Category I, Category II, and Category III. Each category is used for different purposes, such as reporting services, performance measurement, and emerging technologies.
Besides facilitating accurate reimbursement, CPT codes provide valuable data for healthcare providers and payers. They help analyze healthcare trends, service utilization, and provider performance, which can inform decisions about healthcare policy and resource allocation.
In summary, understanding CPT codes is vital for private practitioners to navigate the complex medical billing and reimbursement world and provide high-quality care to their patients.
CPT Vs. ICD Codes: Understanding the Key Differences
To effectively distinguish between CPT and ICD codes, it’s important to have a solid grasp of their differences. Although both codes are crucial for effective communication among healthcare providers and facilities, keeping certain distinctions in mind is important. These include:
| CPT Codes | ICD Codes | |
|---|---|---|
| Purpose | ICD codes are used to identify medical diagnoses and necessities. | Medical procedures and services can be identified using CPT codes, which are mainly utilized for billing and reimbursements. |
| Issuing Body | The American Medical Association (AMA) is responsible for maintaining the CPT codes, making them federal. | The World Health Organization (WHO) organizes the ICD codes, making them international. |
| Versions and Updates | Interventions and procedures that happen during client interactions are referred to as CPT codes, and they are subject to frequent updates. The reason for this is the constant development of new treatments, and CPT codes must reflect precisely and accurately what occurred in every encounter. | ICD codes undergo revisions every ten to fifteen years, and the process is more challenging to regulate for international applications than for federal ones, resulting in a longer duration for the changes. The revisions made are generally substantial when the codes are revisited. |
| Categorization | CPT codes are categorized based on the medical treatment and procedures administered. | ICD codes are categorized based on body systems or conditions. |
| Simplicity | It's common to use multiple interventions or procedures during a client session, which can make CPT codes more intricate than ICD codes. Additionally, various codes and procedures may apply to the same disease or condition. | ICD codes are simpler because there is just one code for each condition and its diagnosis. |
What Is Telemedicine?
Medical care provided to patients remotely, where they can communicate with their healthcare provider in real-time using electronic audio and visual means, is known as telemedicine. In the US healthcare system, telemedicine and telehealth are often used interchangeably. It’s important to note that the reporting of these services can vary depending on state regulations and the payer involved.
As per a survey conducted among physicians in the US by Statista, it was found that before the COVID-19 outbreak, 65% of the respondents had not utilized telehealth. However, 43% of clinicians resorted to telehealth technology during the pandemic’s peak to cater to over 50% of their patients. Furthermore, in the upcoming years, 43% of healthcare providers aim to continue using telehealth services for around 10-49% of their total appointments.
Importance of Following ICD-10 and CPT Codes for Telemedicine
Medical practices offering telehealth services must always adhere to the ICD-10 and CPT coding guidelines. Neglecting such codes is not an option for hospitals, physicians, or other medical service providers. Incorporating telehealth strategies into their practice is necessary to remain competitive in the medical business.
Despite the benefits of telehealth, providers may face challenges due to the broad range of complex situations. From remote monitoring of stroke patients to virtual convenience care, telehealth encompasses managing acute and non-emergent conditions quickly, effectively, and cost-efficiently.
As the medical landscape of care expands, telehealth billing and coding must also be a priority. Thus, telehealth medical providers should adhere to three core principles. If you want reimbursement from an insurance company, you must provide certain ICD-10 and CPT codes.
List of all ICD/CPT Codes for Telemedicine
| Telehealth Encounters | ||
|---|---|---|
| 99201 – 99215 | Visits to a medical office or other outpatient setting. | New and established patients. |
| G0425 – G0427 | These codes are used for telehealth consultations, emergency departments, or initial inpatients. | New and established patients |
| Virtual Check-ins | ||
|---|---|---|
| G2010 | As a healthcare provider, you can evaluate recorded video and/or images submitted by a patient who has already established care with you. This includes interpretation and follow-up with the patient within 24 business hours. However, this evaluation should not originate from a related E/M service provided within the previous seven days, nor should it lead to an E/M service or procedure within the next 24 hours or the soonest available appointment. | Established patient. |
| G2012 | A quick chat between a medical professional and an established patient is conducted via technology, such as a virtual check-in. The medical professional will provide evaluation and management services, and the chat should not be related to any previous service provided within the past seven days, nor should it lead to any service or procedure within the next 24 hours or the soonest available appointment. The discussion should last 5-10 minutes and focus on medical topics. | Established patient. |
Practitioners who are unable to bill for E/M services can now bill for two newly created G codes that CMS has finalized. These codes, namely G2250 and G2251, are within the benefit categories of certain non-physician practitioners.
| HCPCS G Code | ||
|---|---|---|
| G2250 | An established patient can submit recorded videos and/or images for remote assessment (also known as store and forward). The provider will interpret the results and must provide follow-up within 24 hours. This service cannot be related to a service provided within the past seven days and cannot lead to a service or procedure within the next 24 hours or the soonest available appointment. | Established patient. |
| G2251 | A short conversation via technology-based service between a trained healthcare provider and a patient who has already received care that does not include a formal medical evaluation or management and is not related to any recent or upcoming medical procedures or appointments. This discussion lasts for about 5 to 10 minutes. | Established patient. |
| G2252 (Starting January 1, 2022, CMS implemented a new system that provides separate coding and payment for the extended virtual check-in service, documented under G2252.) | A medical professional can offer a short, technology-driven consultation service, such as a virtual check-in, to an existing patient. This service includes assessment and management services and lasts 11-20 minutes. It should not be related to an E/M service provided in the past week or lead to a procedure or E/M service in the next 24 hours or the next available appointment. The extended virtual check-in service payment has been cross-referenced to the reimbursement for the Current Procedural Terminology (CPT) code 99442. | Established patient. |
| E-Visits | ||
|---|---|---|
| 99421 –99423 | An established patient can take advantage of an online digital evaluation and management service for up to 7 days. | Established patient. |
| G2061 – G2063 | An evaluation conducted online by a certified healthcare expert who is not a physician. | Established patient. |
| Telephone Services | ||
|---|---|---|
| 99441 –99443 | A physician or other qualified healthcare professional can conduct a phone assessment and management service for an existing patient, parent, or guardian. This service should be separate from an E/M service provided within the last week or lead to an E/M service or procedure within the next day or the next available appointment. | Established patient. |
| Interprofessional Telephone/Internet/EHR Consultations | |
|---|---|
| 99446 – 99449 | A consultative physician offers an interprofessional service for assessment and management via telephone, internet, and electronic health records. They provide a verbal and written report to the patient's treating or requesting healthcare professional. * Time for medical consultation and review is included in every code. |
| 99451 | A physician offers an interprofessional assessment and management service over the phone, internet, or electronic health record. The service includes a written report to the patient's treating or requesting physician or other qualified healthcare professional. The medical consultation time lasts for five minutes or more. |
| 99452 | A qualified healthcare professional or treating physician can utilize an interprofessional referral service via telephone, internet, or electronic health records for 30 minutes. |
The modifier 95 signifies a telemedicine service delivered synchronously through a real-time interactive audio and video telecommunications system.
Appendix P in the 2020 CPT® manual summarizes CPT codes that can be utilized for reporting synchronous (real-time) telemedicine services when appended by modifier 95.
The procedures listed in this summary involve electronic communication using interactive telecommunications equipment that includes, at the very least, audio and video.
| HCPCS Level II Telehealth Codes | ||
|---|---|---|
| G0406-G0408 | It can be utilized for follow-up consultations with inpatients using telehealth. | Established patient. |
| G0425-G0427 | Telehealth consultation, emergency department. | New patient. |
| G0508, G0509 | Telehealth consultation, critical care. | New and established patient. |
Some Examples of ICD Codes for Different Diagnoses
Discussed below are some examples of ICD-10 codes for different diagnoses:
ICD-10 for Hypertension
Individuals who meet the criteria for hypertension and do not have any comorbid heart or kidney disease are classified under a single code in ICD-10, which is identified as I10, essential (primary) hypertension.
ICD-10 for Pneumonia
J18.9 can be utilized as a billable and specific ICD-10-CM code to identify a diagnosis for the purpose of reimbursement for pneumonia, an unspecified organism. Under the category of diseases of the respiratory system, WHO has listed this medical classification.
ICD-10 for Physical Therapy
If you want reimbursement from an insurance company, you must provide certain ICD-10 codes for physical therapy. You can choose several codes that accurately depict the primary condition and its related symptoms, but only one code will be designated as the primary code.
- M84 – It is used for disorder of bone continuity
- M84.3 – It is related to stress fracture
- M84.31 – It can be used for stress fracture in shoulder
- M84.311 – You can use it for the diagnosis of stress fracture in the right shoulder
- M84.311D – It can be utilized for stress fracture in the right shoulder, subsequent encounter for fracture with routine healing
Bottom Line
This detailed guide provides a thorough overview of the ICD and CPT codes. It also discussed the major differences between the two coding standards and their importance in reimbursing telemedicine visits. Besides, a list of all CPT/ICD codes for telemedicine, along with a description and type of patient, was included to better understand the telemedicine coding and billing guidelines.
Frequently Asked Questions
Standardized terminology for coding medical procedures and services is offered by the Current Procedural Terminology (CPT®) codes. These codes play a significant role in enhancing accuracy and efficiency by streamlining reporting. They are also utilized for administrative purposes, including claim processing and creating medical care review guidelines.
The ICD-10 aims to ensure that mortality statistics are comparable across different countries by providing a standardized system for collecting, processing, classifying, and presenting them.
Accurate documentation of patients’ diagnoses and treatments is crucial for tracking patient outcomes, identifying health trends, and providing appropriate patient care. These codes facilitate this process effectively.
Can you put it in different words? Although CPT codes are akin to ICD-10 codes, CPT codes are used to specify procedures performed, whereas ICD-10 codes are used to indicate patient diagnoses.
Diagnostic coding in the US is categorized under ICD-10-CM (Clinical Modification), while inpatient hospital procedure coding is categorized under ICD-10-PCS (Procedure Coding System).
To claim complete reimbursement from insurance providers, telehealth services rely on ICD–10 codes to establish their medical necessity.
While implementing the codes for telehealth, it’s important for coders to keep in mind four key areas: Place of Service (POS), Modifiers, Cost-Share Waiver, and Cost-Share Coverage.
