Today’s savvy healthcare consumers increasingly demand affordability and convenience, yet many practices struggle to meet and exceed patient expectations. For example, in areas with physician shortages, patients may wait weeks or even months for an appointment. When they finally do get an appointment, they may be frustrated when told they simply need to ‘wait it out’ to feel better or that there’s nothing new that can be done—especially when they’re paying a 20 percent Medicare Part B co-payment for an in-person office visit.
What if physicians had an easy way to assess each patient’s problem to determine whether they truly needed to come in for a visit? The good news is that now they do. As of January 1, 2019, Medicare began paying for two services that provide patients with affordable and convenient options in lieu of a face-to-face visit:
- G2010 (remote evaluation of patient-submitted images and video)
- G2012 (virtual check-ins)
“These codes illustrate CMS’ willingness to support providers who are increasingly using technology to make care most cost effective and satisfactory to patients,” says Emily H. Wein, healthcare lawyer at Foley and Lardner, LLP and member of the firm’s national Telemedicine and Digital Health Industry team.
Although payment is nominal (i.e., G2010 pays approximately $12, and G2012 pays approximately $15), the main impetus behind providing these services is to boost patient satisfaction and enhance healthcare quality and efficiency, says Wein.
Other benefits include:
- Increase physician availability to meet face-to-face with patients who have more complex medical needs
- Decrease patient co-payments as well as the overall cost of care, the latter of which is an important factor in value-based payment models
- Potentially reduce physician burnout because it lessens the need to double and triple book appointments
One interesting aspect of these services is that CMS doesn’t consider them telehealth. This means they aren’t subject to restrictive statutory requirements, says Wein. For example, Medicare will only pay for telehealth services when the beneficiary receives the services in an authorized originating site that’s located in a rural Health Professional Shortage Area or a county outside a Metropolitan Statistical Area. With G2010 and G2012, location is irrelevant, she adds.
What you need to know about G2010 and G2012
Consider the following:
- G2010 is for the remote evaluation of recorded video and/or images submitted by an established patient. G2012 is for a brief communication technology-based service for an established patient, including audio-only real-time telephone interactions as well as synchronous, two-way audio interaction with video or other data transmission. Note: An established patient is one who has received professional services from the physician or qualified healthcare professional [or another physician or qualified healthcare professional of the exact same specialty and sub-specialty who belongs to the same group practice] within the past three years).
- G2010 and G2012 include interpretation with follow-up (i.e., a 5-10 minute discussion with the patient) within 24 business hours.
- G2010 and G2012 cannot originate from a related E/M service provided within the previous seven days nor lead to an E/M service or procedure within the next 24 hours or soonest available appointment.
- The provider who renders services associated with G2010 and G2012 must be a physician or other qualified health care professional who is able to furnish E/M services.
- When rendering G2010 and G2012, practices must collect a patient co-payment (i.e., 20 percent of the Medicare Part B allowable amount).
- Practices must obtain and document advance patient consent to receive services associated with G2010.
- Practices must obtain and document consent for each virtual check-in associated with G2012.
When you can—and can’t—report G2010
Physicians may be able to report G2010, for example, when an established patient takes a picture of their rash and uploads it to the patient portal or other HIPAA-compliant communication platform where the physician reviews the image, talks to the patient on the phone within 24 hours, and ultimately prescribes a steroid cream that solves the problem.
Following are several examples of when it’s not appropriate to report G2010:
- A provider remotely evaluates an image of large bruise on an established patient’s head that prompts an in-person visit within 24 hours or the next soonest available appointment so the physician can check for signs of a concussion. This service is bundled into the relevant in-office E/M code.
- An established patient sees their physician after having knee surgery. Within seven days of that visit, the patient sends a video of their gait so the physician can remotely review it and make sure they’re progressing as planned. This service is bundled into the relevant in-office E/M code.
- An established patient sends a text-based message through the portal or other HIPAA-compliant platform to their physician regarding a rash on their torso but doesn’t send an image or video. The physician review the information and responds via the portal telling the patient to call the office for an appointment. This service is not billable.
When you can—and can’t—report G2012
Physicians may be able to report G2012, for example, when an established patient sends a message via the portal or other HIPAA-compliant platform regarding a sore throat. The physician then briefly communicates with the patient in real-time (e.g., via telephone or via a portal with audio-video capabilities) to advise whether the patient actually needs to come in for an in-person visit. The physician determines that no in-person visit is necessary and instructs the patient to call the office if symptoms worsen.
Following are two examples of when it’s not appropriate to report G2010:
- A physician reviews physiologic data (e.g., blood sugar levels taken from a glucometer that an established patient transmits wirelessly through the portal), calls the patient to discuss the results, and decides that an in-person visit is necessary as soon as possible because the patient’s levels have spiked. This service is bundled into the relevant in-office E/M code.
- A physician diagnoses an established patient with asthma. Within seven days of the visit, the patient uploads daily recordings of their peak expiratory flow rates to the portal. The physician reviews this data and determines that the patient is using their inhaler correctly. This service is bundled into the relevant in-office E/M code.
The sooner practices can offer these services to patients, the better. Patients will eventually demand them, and practices that take the time to design efficient workflows will be one step ahead of the game, says Wein.
Looking for other ways to meet patient expectations? Review this checklist that walks you through how to create a survey to do just that!