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Setting up an order to go to billing with modifier and place of service

CPS, C-EMR, PM

Last Post by Anonymous 1 second ago

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mkherman

(@mkherman)

Posts: 53

Trusted Member

Topic starter

Like many others we are racing to set up telemedicine (both phone and video). Trying to determine the best way to get the proper codes entered.

The codes for telemedicine are the same as in person visit, just needs the GT modifier and a place of service code of 02.

I really do not want to use a separate facility because that is so difficult to do, particularly with mixed days (some visits done in person, and some phone or video).

I was trying to set up codes on the EHR side 99212TM that mapped to the procedures with the place of service and modifier built in. But when we try to send a claim, it gets bounced back as a code with more that 5 digits (sending normal cpt code: 99212).

I am really hoping I am missing something obvious. Any suggestions? Thoughts? I have read the only way people could get the modifier easily added on the EHR side was with MEL_ADD_ORDER which is not a great option.
We are on CPS 12.0.10 if it matters.

Suggestions or thoughts appreciated!

Thank you,

Mary Kay

Posted : March 18, 2020 11:38 am

joeg1962

(@joeg1962)

Posts: 843

Noble Member

Not sure about the location '02' that you referred to, but within a new VFE form here for telemedicine I have ten buttons for different types of visit. And the programming behind each button follows the pattern of:

{
MEL_Add_Order("S","E&M Services","New Level 1","GT","","","","","","","")
}

Posted : March 18, 2020 11:38 pm

cjames

(@cjames)

Posts: 58

Estimable Member

Try dropping the TM and see if that solves it.

Posted : March 19, 2020 1:47 am

mkherman

(@mkherman)

Posts: 53

Trusted Member

Topic starter

Thanks- was hoping to avoid the need for a custom form... but I am thinking it is the fastest way to go. Staff is very familiar with going to the orders custom list and moving them might get confusing.

Was hoping for better integration between the EHR and PM 🙂

Posted : March 19, 2020 2:00 am

mkherman

(@mkherman)

Posts: 53

Trusted Member

Topic starter

Cjames- do you mean dropping the TM from the order code? The problem is then it is just a regular 99212 code and no way to tell it was a virtual visit.
Or is there a way to do this before sending out the claim? I am not an expert on the claim/billing side.

Thank you

Posted : March 19, 2020 2:01 am

tablok

(@tablok)

Posts: 19

Eminent Member

We set this up mainly on the PM side with the various fee schedules. So in the EMR, they choose a dummy CPT code - like Tele99213. On the PM side, we then set up within the BCBS fee schedule to have the "CPT Code" as 99213. So in CPS, we see Tele99213 - but what goes on the claim is the 99213. So you can also default the modifier and Place of service within the fee schedule as well. This is the best way to handle it because 1 code has to be translated to various codes and modifiers based on the insurance...for instance, we will a G code to Medicare, so we set that up in the fee schedule as well.

Posted : March 19, 2020 3:49 am

cjames

(@cjames)

Posts: 58

Estimable Member

Yes. Keep the modifier of 02 on the billing side. Create a document type of TM, Tele, or whatever you see fit.

Posted : March 19, 2020 6:35 am

ntaylor

(@ntaylor)

Posts: 79

Estimable Member

This is how I have ours setup.

Posted : March 24, 2020 10:25 am

mkherman

(@mkherman)

Posts: 53

Trusted Member

Topic starter

Thank you everyone! I think we figured out where we were going wrong. Something about the allocation set and fee schedule on the PM side.
I had set it up like many of you do where the code on EMR side had the modifier included and the procedure has the code set up the same as the EMR code and the CPT code on the procedure is the basic CPT code.

Here's hoping we get reimbursed for the phone visits now :)...

Thank you again to the great community!

Posted : March 25, 2020 2:05 am

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