Domain: Healthcare & Social Assistance
Question:
An outpatient mental health provider audits it finances and want to know why it's seen an increase in claim denials year over year. One avenue it wants to look at is coding and whether they have been billing correctly. They've also significantly expanded telehealth services in that time period. Their questions are: Which telehealth services can and cannot be billed? What taxonomy codes will cause cliams to be denied? When are add-on codes useful?

Expected points in a correct answer:
States that telehealth services may be billed only when the CPT or HCPCS code is authorized for telehealth delivery.
States that the claim must accurately reflect whether the service was delivered via audio-only or audio-video.
States that the claim must accurately reflect the patient's location (e.g., whether the patient was located at home)
States that providers must document whether the patient was present and located at home, as these elements determine place of service and modifier requirements
States that whether the service was delivered via audio-only or audio-video determines the place of service requirements.
States that 90834 may be billed via telehealth when payer requirements are met.
States that 90837 may be billed via telehealth when payer requirements are met.
States that 90834 may be billed via audio-only telehealth when permitted, provided appropriate modifiers are used.
States that 90837 may be billed via audio-only telehealth when permitted, provided appropriate modifiers are used.
States that audio-only billing for 90834 and 90837 requires documentation of why video was not utilized.
States that 90839 is not permitted via telehealth under California DHCS Specialty Mental Health Services and DMC-ODS programs.
States that when crisis intervention is provided remotely, H2011 must be used instead of 90839.
States that payers validate telehealth claims by comparing the provider taxonomy to the procedure code requirements.
States that services are denied when there is a mismatch between the provider taxonomy and the procedure code.
States that billing licensed clinician CPT codes under peer or non-licensed taxonomy codes cause denials.
States that billing peer-specific HCPCS codes under licensed clinical taxonomy codes causes denials.
States that billing trainee services without the correct trainee taxonomy designation causes denials.
States that add-on codes may be reported only when all required criteria are met.
States that G2212 may be used only when the primary service does not include its own prolonged-service add-on.
States that G2212 may be used only when the required additional time threshold is reached.
States that other add-on codes may be billed only when directly related to the primary telehealth service.
States that other add-on codes require supporting documentation to be billed.
States that improper use of telehealth add-on codes is a frequent trigger for denials.
States that modality and location documentation determines the modifier requirements.
States that failure to accurately report location is a common cause of claim denial.
States that improper use of telehealth add-on codes is a frequent trigger of post-payment review findings.
States that psychotherapy for crises (CPT 90839) is specifically the service not permitted via telehealth, distinguishing it from general psychotherapy codes.
Mentions interpretation services as an example of add-on codes that may be billed alongside telehealth services.
States that certain outpatient mental health services are approved for telehealth when payer requirements are met.
States that telehealth claims are frequently denied when the rendering provider taxonomy code does not support the billed service.