Friedman: 8 Rules to Know for Telehealth Medical Treatment Exams

Monday, April 13, 2020 | 0

On March 19, the California Division of Workers’ Compensation announced rules for telehealth medical treatment for the duration of the COVID-19 pandemic:

Heywood G. Friedman

• The DWC encourages all parties to consider creative solutions appropriate for providing care to injured workers. Therefore, the DWC extends great latitude to allow injured workers to receive much-needed medical care.
• The health care provider initiating the use of telehealth shall inform the patient about the use of telehealth.
• The health care provider shall obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health.
• The consent shall be documented.

Although the March 19 DWC announcement did not provide a definition of the services encompassing “telehealth,” we believe that the following protocols should also be followed as to an examination involving a video connection:

• The video connection device should allow both the doctor and patient to see each other. An examination that involves either the patient or the doctor to participate via telephone only does not qualify as a telehealth service. Although a telephonic medical treatment examination where the doctor and patient do not see each other is allowed under California workers’ compensation law, it is not to be called a telehealth examination or billed as such. A total separate billing is required for telephonic examinations and can be found under CPT billing codes 98966, 98967, 98968, 99941, 99942 and 99943.
• Rules that govern a telehealth examination may be promulgated only by the DWC. An insurance company is not allowed to establish additional criteria, impose additional requirements or refuse to allow telehealth examinations. Further, the insurer does not have the legal authority to object to or refuse to pay for telehealth treatment examinations.  
• Also, the broader rules governing California workers’ compensation telehealth differ from those imposed by Medicare, which is more restrictive. For example, Medicare publishes a list of 186 procedures approved for telehealth services along with yet another list identifying the types of eligible providers authorized to perform telehealth services. Neither list exists under the California workers’ compensation system. So long as the services are clinically appropriate, they may be offered under our state’s workers’ compensation system.
• Another significant difference between Medicare and California workers’ compensation involves how telehealth services are to be billed. For Medicare billing, box 24B of the standard CMS 1500 form should be populated using the appropriate location code. Although code “02” identifies telehealth services, code “02” is not to be used at this time for Medicare billing during the COVID-19 pandemic. Instead, the provider should use another code, such as code “11,” which represents a regular office visit. In addition, Medicare requires a modifier of “95” to be added when filling out the service code. In comparison, per CCR 9789.12.2, under our California workers’ compensation system, box 24B must be populated with the number “02” to identify a telehealth visit. However, the service code does not require a modifier. As a result, a provider of a California workers’ compensation telehealth service will be paid slightly lower for a telehealth exam than that which they would be paid for an in-person office exam as telehealth is paid at the lower facility reimbursement rate as opposed to the usual location fee rate.

The bottom line is that the rules pertaining to telehealth medical services under Medicare and the California workers’ compensation system differ significantly. Providers and workers’ compensation medical bill reviewers must be careful to not confuse them.

Heywood G. Friedman is the founder and managing partner of the Law Offices of Friedman & Bartoumian in Agoura Hills, California.