How to Handle Cardiology Telehealth Billing

Telehealth has become a game-changer in cardiology, making it easier for patients to access care from the comfort of their homes. But with this convenience comes a new challenge: billing for telehealth services. 

If you’re a healthcare provider or billing specialist, you might be wondering how to handle cardiology telehealth billing effectively. Don’t worry—this guide will walk you through everything you need to know in simple, easy-to-understand language.

Why Telehealth is Important in Cardiology

Cardiology patients often need regular check-ups, especially those with chronic conditions like heart failure or hypertension. Telehealth allows doctors to monitor these patients without requiring them to visit the clinic every time. It’s convenient, saves time, and ensures continuous care.

However, billing for telehealth services isn’t the same as billing for in-person visits. There are specific rules, codes, and modifiers you need to follow to get paid correctly. Let’s break it down step by step.

Step 1: Verify Insurance Coverage for Telehealth

Before offering telehealth services, check if the patient’s insurance covers them. Different payers (like Medicare, Medicaid, and private insurers) have different rules. For example:

• Medicare: Covers telehealth for many cardiology services, but only if the patient is in a qualifying area.
• Private Insurers: Coverage varies, so always verify beforehand.

Pro Tip: Use your billing software to check eligibility and coverage details before the appointment.

Step 2: Use the Right CPT and ICD-10 Codes

Coding is the heart of telehealth billing. Here’s what you need to know:

Common CPT Codes for Cardiology Telehealth

• 99421-99423: For online digital evaluations (e.g., reviewing patient messages or data).
• 93228: For remote cardiac monitoring.
• 99212-99215: For virtual office visits (depending on the complexity of the visit).

ICD-10 Codes for Cardiology Conditions

• I10: For hypertension.
• I50.9: For heart failure.
• I25.10: For coronary artery disease.

Always double-check the codes to ensure they match the services provided.

Step 3: Add Telehealth Modifiers

Modifiers tell the insurance company that the service was provided via telehealth. Here are the most common ones:

• Modifier 95: Used for synchronous telehealth (real-time video or phone calls).
• Modifier GT: Required for Medicare telehealth claims.
• Place of Service Code 02: Indicates the service was provided via telehealth.

Example: If you’re billing for a virtual consultation, your claim might look like this:

• CPT Code: 99213 (Office visit, 20 minutes).
• Modifier: 95 (Telehealth service).
• POS Code: 02 (Telehealth).

Step 4: Document Everything Accurately

Good documentation is key to avoiding claim denials. Make sure to include:

• Patient consent for telehealth services.
• Details of the visit (e.g., symptoms discussed, advice given).
• Technology used (e.g., video platform name).

Pro Tip: Use templates in your EHR system to streamline documentation.

Step 5: Submit Claims and Follow Up

Once the claim is ready, submit it to the insurance company. If the claim is denied, don’t panic. Common reasons for denials include:

• Missing modifiers.
• Incorrect codes.
• Lack of prior authorization.

Review the denial reason, correct the error, and resubmit the claim.

Common Challenges in Cardiology Telehealth Billing

1. Varying Payer Policies: Each insurance company has its own rules for telehealth. Stay updated to avoid surprises.
2. Technical Issues: Ensure your telehealth platform is secure and HIPAA-compliant.
3. Patient Confusion: Some patients may not understand telehealth billing. Educate them upfront to avoid disputes.

Best Practices for Smooth Telehealth Billing

1. Train Your Team: Make sure your billing staff understands telehealth-specific requirements.
2. Use the Right Tools: Invest in billing software that supports telehealth coding and claims.
3. Stay Updated: Telehealth regulations change often. Regularly check for updates from CMS and other payers.
4. Audit Your Claims: Conduct regular audits to catch errors before they lead to denials.

FAQs About Cardiology Telehealth Billing

1. What are the most common CPT codes for cardiology telehealth?
   Common codes include 99421-99423 for digital evaluations and 99212-99215 for virtual office visits.
2. How do I bill for remote patient monitoring?
   Use CPT code 93228 for remote cardiac monitoring and include the appropriate modifiers.
3. Can I bill for telehealth if the patient is out of state?
   It depends on state laws and payer policies. Always verify before providing the service.
4. What modifiers are required for telehealth billing?
   Use Modifier 95 for most payers and Modifier GT for Medicare.
5. How do I handle denied claims?
   Review the denial reason, correct the error, and resubmit the claim.

Conclusion

Handling cardiology telehealth billing doesn’t have to be complicated. By following the steps above—verifying insurance, using the right codes and modifiers, documenting accurately, and staying updated—you can streamline the process and avoid costly mistakes.

Telehealth is here to stay, and mastering its billing process will help you provide better care while keeping your revenue cycle healthy. If you need help, consider investing in telehealth-specific billing tools or consulting with a billing expert.

Choosing the right cardiology billing services can make all the difference in ensuring accuracy, compliance, and efficiency. Whether you handle billing in-house or outsource it, make sure your team or service provider is well-versed in cardiology and telehealth billing.