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Hey, greetings, my friends. This is Sam Collins, your coding and billing expert for chiropractic, Chirosecure, and of course the profession here with another program for you to update you on what’s new for the year. And of course, there’s always updates to CPT and coding, but it’s always important to know what codes have updated.
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What has changed this year? There are some new codes for telemedicine. Let’s define telemedicine, making sure there’s an understanding of how we do it. The old way was to use E& M codes. We now have a whole new code set for telemedicine, audio video, as well as audio only. So let’s go to the slides. Now, I want to be careful when I’m talking about telemedicine, obviously during the pandemic and those that may have been a little bit more prominent, but realize that is still something viable.
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And there could be instances that this could fit where you’re going to have a counseling visit or an initial visit where the patient otherwise can’t come in, but you do it via telemedicine. There’s a way to do that now, but it’s a way to do it. Unlike before, there’s brand new codes, but let’s do this though.
Let’s define telemedicine, make sure we’re on the right track. What do we mean by telemedicine? Telemedicine, what I’m referring to is that audio video visit. So basically a face to face visit. But it’s just done over video conference, as opposed to being in the same room. So it’s live audio video.
It can’t be recorded, if you will. If the patient records something, you listen and say something back, it’s gonna be live. So think of it, this is a face to face visit. The only thing about this, though, with telemedicine, do make sure you understand your licensure. This is often confusing because people think because I can do telemedicine, I can do it anywhere.
Virtue of the media, maybe, But let’s talk about what you can do per your license. It says make sure you are licensed in both the state where you are located, obviously, but in the state where your telemedicine patient is located. So by example, if you’re in California, and you have a patient that’s in Washington or Texas or any place other than California, you cannot do telemedicine with them.
Why? You’re not licensed in the state they’re at. Think of it simply traveling. If you were to travel to their state, Could you treat them? No. Therefore, telemedicine means you also can’t. They have to be in your state. Now, obviously, if they came to your state, you could treat them. You’re licensed in your state.
But be careful. Licensees don’t have that reciprocity. They don’t have a reciprocal arrangement where in most states, you can just simply say, Oh, good. If I practice here, I can practice anywhere. You can’t do that as a chiropractor. So do be careful. Don’t start thinking, Hey, good. I’m going to do a national coverage on some, whatever the issue you might deal with, not as a chiropractor, you want.
Remember, your chiropractic license dictates you may practice in your state. Now, that being said, I’m excited because they’ve added some new codes that are very specific to what we do with telemedicine. Now, if you recall, the prior way we did this was you would do a telemedicine visit was built with an E.
M. Code. You would put modifier 95 and all that. That’s changed now they now for 2025 have implemented codes that are specific to new patient and established patient, just like E and M codes that take over for telemedicine. So notice the first one, the new code 9800 synchronous audio video visit for the evaluation of management of a new patient, which requires a medically appropriate history and examination.
Now, actually that is literally the same language as a 99202. Or any ENM code, the same language. The only difference is it says synchronous audio video. So what these codes do is just take over and say, you no longer have to use a modifier 95. Because this directly already tells you it’s that. Everything else is the same though.
You’ll notice it says straightforward medical decision making. What does straightforward mean? One simple complaint. That’s what straightforward medical decision making is. However, it also uses the same protocol of 15 minutes. So it could be for 15 minutes or straightforward. Which means, what if you spend only 10 minutes, but it was still completed adequately, it’s still billable.
Time is only one of the factors. Okay. It could also be based on severity. The key factor here is brand new code telemedicine, just like an E and M 9, is equivalent to a 9 9 2 0 2 new patient. New patient is the same thing. By the way, new patient means someone you’ve seen never before. Or haven’t seen him three years or greater.
Now they break down the same way. It’s all the same. It says, this one says, which requires medically appropriate history and exam. The only difference here, this one says medical decision making. That is low level. Now what does low level mean? Low level means two complaints. Okay. But I think the more important factor is just simply time.
I think this is how these work 15 minutes, 30. 45 or 60. Because by example, I don’t think we’re doing a telemedicine visit where the severity hits what we call that high level. Why? Because a telemedicine visit that is high level. What’s the life or death situation? Should you be doing a telemedicine visit for that?
I see that teasing. I’m not saying impossible, but just be mindful. Not likely, but it could be based on time. Let’s take that patient that you’re doing with them that first visit, and they just got a crazy history. They’re a P. I. Patient or a cop patient where The exam is going to take easily an hour and they don’t have an hour to come in the office.
So you say, Hey, let’s start this with telemedicine. Let’s get an audio video going. Let’s do it at five o’clock today, get on there and do the same thing. Now realize it’s just like a face to face visit. You don’t record. The visit itself, but what you do is you document it just like a face to face visit.
Same thing applies. How are you feeling today? And I will say, obviously the history can be just as good. Family history, past history, all those things. Review of systems, I think fit really well. But there’s parts of the exam you still might do. Can you do a visual exam of the patient? Now, I’m always careful about skin color, but for the most part, yes.
Can you do ranges of motion? I think adequately depending on where they can place the camera. So there are elements you can do, but you don’t, I think this visit mostly is a counseling, you’re discussing with the patient, the parameters of what’s going on, what doctors have you seen? So I think these fit well, the whole point of this is.
Telemedicine is here to stay because instead of just using an E and M code, they created their own code set. So these here are going to be new patient and there’s one for an established patient. And by the way, works the same way. Established patient means someone you’ve seen in the last three years and notice it’s going to be, straightforward, low and so forth.
10 minutes, 2030 40. So again, 12131415. Now, is that very hard? No. Is that a change? You’re gonna go, Oh, my God, it’s earth shattering. No, but I bet for many car was, in fact, the ones I deal with, because I lecture to a lot of you per year. I generally find there are chiropractors that are doing these relatively regularly in some instances.
I’m not against it. Just make sure it’s documented bill appropriately. Now you might think, Oh, what’s gonna be the cost? RV use Are updating this year, and I’m going to do next month. We will do an RVU one, but I’m going to say these are about 80 percent of the fee that you charge for the E& M code, approximately.
Not as expensive, obviously, because it is telemedicine. There’s less cost, but nonetheless, not free or not cheap. Telemedicine, are there new codes? Yes, here they are. 98001 through 98007. So again, new patient, established patient, pretty straightforward. These are ones I think can happen. I don’t want to try to over talk you into it because certainly let’s be honest, does telemedicine really work for chiropractic in the big picture?
No, but in a small picture, could it be an aid in helping to get the patient in? Again, I go with a patient that they’re going to miss a visit. Instead. I do this, do a counseling visit in between the week, or they can’t come in for an hour visit. So maybe, I schedule a half hour, but I know it’s not going to be enough.
The first half hour I do this way. So there’s a place for it. Insurances do cover it, and remember, equality says if they cover it for one, they cover it for all. Here’s a problem. What about plans you belong to? Will OptumHealth cover this? Technically they will, but they’re not going to pay you any extra for it.
You’re still going to get the same money you always got. I’m not aware of ASH allowing it into the plan, but I would assume they do. But again, remember, I think it’s going to be just the same price. You’re not getting anything extra. And the truth is I need to be treating people because realistically for you really to do your work, we’ve got to adjust people, but this part can be part of what’s going on.
That brings me to the next set of codes, which are called synchronous audio visit. I like to call it telephone audio. That shows you I’m old. In fact, I was someplace last week. There was actually a pay phone. I had to bring a friend into the emergency room when that anyway, there were pay phones. Anymore. I thought I’d make sense, though, because maybe some doesn’t have a cell phone.
Needless to say, telephone is weird because you don’t have to use a telephone. And I’m what I’m saying here is they made this clear. It’s not telephone only. It’s an audio visit. Realize you could do audio through lots of different ways. So that’s why they don’t say telephone. But for my old school purposes, I’ll say telephone.
And these are the new codes. If you have been using the old codes for telephone calls 99441 and so on. Throw them out. They’re no good. These are the new codes for this year. Now these are going to be the same thing You’re going to notice. Oh, it’s a call for 15 minutes a court for 30 minutes These are pretty easy to use you just document how much time Did I spend 15, 20, 30, 45, and so on?
Here’s the problem with these though. If you’re doing a telephone or an audio visit only, is it billable when a patient has been seen within the previous 7 days, or the result of that, a call if you will, is to set up an appointment? By example, I’m hurting. Maybe I saw you last week. But I’m hurting. I’m hurting today.
And I call you and say, Oh, my God, Doc, my back is killing me. Maybe you do spend a few minutes saying, Okay, here’s what you have to do. Get some ice on it. Do certain stretches. I get that. But what is probably the result of that phone call going to be? Oh, let’s set you up for an appointment tomorrow. Let’s get you in this afternoon.
If the result of the call is to set up an appointment, the phone call is not billable. It’s embedded into the visit that’s coming up. It’s also embedded, though, into a visit in the previous seven days. So what I’m trying to highlight here is that these codes are viable. So But are they reasonable for what we often do?
In theory, in order for this to be billable, it would have to be a phone call in a patient you haven’t seen in the previous seven days, and the result of the call doesn’t result in the patient coming in for a visit. And I think we all can suspect that’s a pretty weird circumstance. So I’m gonna say, is it possible?
Sure. Is it typical or something that is likely? Probably not. So keep in mind, a lot of times when things update, people get all excited. By example, when I went over with you the diagnosis codes. I think there were some important codes, because it was disk, but was it earth shattering, changing something you use every day?
So always be careful when someone says, you better buy a new code manual. Slow down. That’s why we do a program like this to go, yeah, there’s some new codes, but is there something that we’re using? And again, just telephone only. Okay. And again, these now go with established patient or new patient. But again, if it results in a visit, not going to happen.
The other new code though, is technology communication. And this is where patients contact you via the portal of your system. The difficulty here is, when you do this, does it fit? The system I have, because this is not a brief communication through email. It’s what’s often referred to as a virtual check in where you have an electronic health record system that the patient has a login.
When they log in, they can then communicate with you or the doctor communicates back. That’s what this is for. I don’t see that happening in our places. What are they checking to do? What this is probably intended for, Bess, is a check in for a person that checks their blood pressure daily. Or check their blood sugar to report to the doctor where they’re at in the doctor reviews and makes a decision about medication.
For us, I don’t think common. I bring this up to make sure that you’re going to hear, I heard there’s new codes and oh, we’re going to Yes, there’s new codes. Might you use them? Maybe, but understand their use and where they’re going to be. Here’s the real truth. Where is chiropractic the most effective?
Getting hands on a patient. Now, I do think the audio video one may have more room. I don’t think the phone calls do too much because the result of the phone calls almost always lets you get in for a visit. Bottom line is, continue to do what you’ve always done. Do good care of your patients. Remember, you’re important to a lot of people.
Okay, I get that, and it’s good to be important, but it’s more important to be good, and that good comes through how you treat someone, and that treatment almost is always hands on. As always, I’m going to say to all of you, thank you for being with us. I hope this was some information that keeps you updated on what’s going on.
I’m so happy you were with us today, everyone. I hope that you see how these codes can fit you, and that where you’re going to start to understand where to use them, how to best use them, but also, understanding that we’re going to have more for you that’s coming up for the new year. Next month we’re going to do some RVUs to understand the values of these as well and until then be well but always get out there and be the best doctor you can.
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