Say Cheese! Medicare Is Paying for Photo and Video Evals in 2019

If a picture is worth 1,000 words, how much is evaluating a picture worth? Medicare has taken a stance on that. As of Jan. 1, 2019, Medicare is paying for remote evaluation of pre-recorded patient videos and images reported using G2010. Here’s what we know from the Medicare Physician Fee Schedule Final Rule.

Compare Our Code G2010 to G2012

The code introduced to represent this image/video eval service is the descriptive G2010 (Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment).

How G2010 is like G2012: Some of the descriptor language is similar to that for another new code, G2012 for virtual check-ins. Both codes apply only to services for established patients. Both codes also have a rule about not being connected to a related E/M within the previous seven days or leading to an E/M service or appointment within 24 hours (or soonest available). These rules about appointment timing are important because both services are used to determine whether a patient needs an office visit or other service. Remember the rules if the physician evaluates the photo or video and determines that the patient does need to come in.

How G2010 is NOT like G2012: Virtual check-in code G2012 applies to services like real-time phone and video calls between a provider and an established patient. Our code-in-focus, G2010, represents a practitioner evaluating a pre-recorded still image or video taken and sent by a patient, followed by the practitioner’s response to the patient.

See how rate’s compare: The Medicare national rate for image eval code G2010 is $9.37 in the facility setting and $12.61 in the non-facility setting. For virtual check-in code G2012, the rates are $13.33 in the facility setting and $14.78 in the non-facility setting.

Keep These Pointers In Mind Before Using G2010

Get consent: The MPFS Final Rule (p. 122) states Medicare requires “beneficiary consent that could be verbal or written, including electronic confirmation that is noted in the medical record for each billed service for HCPCS code G2010.” One reason this consent is so important is that cost sharing applies, and the patient needs to know about any financial obligation.

Expect monitoring: Medicare will be watching use of this code for things like overutilization, indications that valuation or billing rules should change, and attempts to get around the timeframe rules (see Final Rule pages 120, 122, 123). That means accurate reporting is essential, both so you can support any review of your coding and so you can let Medicare know how often this service is performed so it gets properly valued in the future.

Know follow-up format: The code requires a response to the patient, and the Final Rule (p. 123) states there are a lot of possible ways this can happen, including phone call, audio/video communication, secure text message, email, or patient portal communication. Whatever your practice chooses, it must be HIPAA compliant and follow any other relevant laws, Medicare states.

Don’t bill for unclear images: If the photo or video quality is not good enough to determine whether the patient needs an appointment, don’t report G2010 for that. You can’t really evaluate a poor quality image. The Final Rule (p. 123) states the expectation in that case is that you’d ask the patient for better images or suggest another option for evaluation.

What About You?

Do you expect to use this code? Many commenters, especially in ophthalmology and dermatology, requested that the code be allowed for new patients, too. Would you like this code to be available for new patients?

 

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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