Telemedicine and Digital Services

E‑Visit (Online Digital E/M)

What it is
An asynchronous, patient‑initiated digital interaction (e.g., portal message) that requires medical decision‑making and occurs over up to a 7‑day cumulative period. The patient is not present in real time.

Common Codes

• 99421–99423 (physician/QHP with E/M in scope)
• Time‑based, cumulative over 7 days

Core Documentation Requirements

• Patient‑initiated request
• Established patient (Medicare; Texas Medicaid generally mirrors)
• Medical decision‑making documented
• Cumulative time tracked across the 7‑day window
• Permanent storage of communication in the medical record
• No related E/M visit in the prior 7 days
• No in‑person or telemedicine visit scheduled within the next 7 days

Compliance Pits & Perils

• Billing for routine portal messaging, test results, or scheduling
• Double‑billing when an in‑person or telemedicine visit occurs within the 7‑day window
• Failing to document time aggregation
• Treating E‑Visits as telehealth (they are not telehealth)

Pearls

• Think: “Message → review → decision → documented plan”
• Excellent for cognitive work that does not rise to a visit
• Do not use POS 02/10 or modifier 95

Key Resources

• CPT® Assistant (Online Digital E/M Services)
• AAFP – Getting Paid for Online Digital E/M Services
• CMS MLN006764 (E/M Services)

Telephone Call (Audio‑Only Patient Communication)

What it is
A real‑time audio‑only interaction with the patient. Post‑2025, this is not a standalone telephone code set for Medicare.

Current Medicare Reality

• 99441–99443 deleted
• Medicare requires reporting standard E/M codes (99202–99215)
• Append modifier 93 when audio‑only is clinically necessary

Core Documentation Requirements

• Reason video could not be used (access, consent, limitation)
• Verbal consent
• Full E/M documentation (history, MDM)
• Time or MDM supports the reported level

Compliance Pits & Perils

• Continuing to use deleted telephone codes
• Treating brief calls as billable E/M
• Missing documentation explaining why A/V was not used
• Assuming commercial or Medicaid rules match Medicare

Pearls

• Audio‑only ≠ casual phone call
• Must still meet E/M standards
• Texas Medicaid and MCOs may still recognize different constructs—verify payer policy

Key Resources

• Noridian Medicare Telehealth E/M Guidance
• ACP Telephone Visits Guidance
• CMS MLN901705 Telehealth & Remote Monitoring

Interprofessional Consult (Provider‑to‑Provider)

What it is
A non‑face‑to‑face consult between providers, performed without the patient present, to guide management.

Common Codes

• 99446–99449, 99451 (consulting provider)
• 99452 (treating/requesting provider)

Core Documentation Requirements

• Treating provider request
• Patient consent (documented)
• Consulting provider’s verbal and/or written report
• Time tracked (consulting provider)
• No face‑to‑face visit with consultant within 14 days before or after

Compliance Pits & Perils

• Billing when advice is informal or undocumented
• No written report
• Consultant subsequently seeing the patient
• Using these when the service is really an ED/IP teleconsult

Pearls

• These are not telehealth services
• Excellent for specialty input without transferring care
• Very audit‑sensitive—structure matters

Key Resources

• McGovern Medical School – Interprofessional Consultation Coding
• CodingIntel – Interprofessional Internet Consults

Inpatient or Emergency Department Telemedicine Consult

What it is
A real‑time audio‑visual consultation with the patient, performed by a distant‑site consultant for ED or initial inpatient evaluation.

Common Codes (Medicare)

• G0425 – 30 minutes
• G0426 – 50 minutes
• G0427 – 70+ minutes

Core Documentation Requirements

• Requesting provider
• ED or inpatient status
• Real‑time A/V modality
• Time threshold met
• Consultant recommendations documented

Compliance Pits & Perils

• Confusing these with interprofessional consults
• Billing without patient interaction
• Using when the consultant later assumes care
• Using for follow‑up inpatient care (different code set)

Pearls

• These are true consultations with the patient
• Common in stroke, neuro, ID, and ICU workflows
• Texas Medicaid policies may differ—verify MCO rules

Key Resources

• CMS Transmittal 3929 (Telehealth Consults)
• HCPCS G0425–G0427 Descriptors (AAPC)
• ACEP Telemedicine FAQ

Compliance Traps 

• Treating everything virtual as telehealth
• Double‑billing overlapping services
• Missing patient consent (especially IPCs)
• Misunderstanding who the service is billed under
• Assuming payer parity where none exists

Final Thoughts

Each of these services fills a different clinical and compliance niche. The fastest way into trouble is collapsing them into “virtual care” without understanding who is involved, whether the patient is present, and what triggers separate payment.

Clear documentation, disciplined code selection, and payer‑specific awareness remain the best audit defense.

Resources

• Evaluation & Management Services – CMS MLN006764
• Telehealth & Remote Monitoring – CMS MLN901705
• Texas Medicaid Provider Procedures Manual (Telecommunication Services Handbook)
• CPT® Assistant (Online Digital & Interprofessional Services)
• AAFP / ACP Telehealth Coding Guidance