Telehealth has become an essential tool in pediatric outpatient care, offering flexibility and accessibility for families while maintaining high standards of clinical care. To ensure compliance and appropriate reimbursement, one  must understand how to properly incorporate, document, and code telehealth visits. 

DEFINING TELEHEALTH VISITS

Telehealth: The use of secure real- time audiovisual communication of such quality as to permit accurate and meaningful interaction between patient and provider. Telehealth shall be rendered via interactive two-way video. Audio-only
telehealth is not permissible unless both of the following
criteria are met:

a. the interactive two-way video fails due to technology or digital literary issues, and;

b. it is necessary and appropriate to continue the visit by communicating through audio-only means to support timely patient care.

Asynchronous Telehealth: involves securely transmitting recorded health history through a secure electronic communications system. The practitioner uses the information to assess or render a service outside of real time or live interaction.

TELEHEALTH VISIT COMPLIANCE

Required Documentation:

· Modality (Video, Telephone, Other)

· Patient location (e.g., home, school, outpatient clinic)

· Provider location (e.g., home, office)

· Identity verification method

· Consent method (verbal, electronic)

GT Modifier: Indicates services were provided via telecommunications. Automatically appended for designated telehealth visit types; otherwise, must be manually added.

When Not Provide Telehealth E/M Services

· Patient is not present with guardian

· Patient is new (unless Telehealth Team exception granted)

· Documentation lacks medical necessity or time/MDM details

· Encounter only involves non-billable activities
(e.g., test results, scheduling)

· Patient is not in a state in which you are appropriately
licensed

CODING TELEHEALTH VISITS

Telehealth can be billed based on either Medical Decision Making (MDM) or Time.

MDM-Based Billing, which is defined by three elements:

· The number &  complexity of problem(s) addressed during
the encounter

· Amount and/or complexity of data to be reviewed and
analyzed

· The risk of complications, morbidity and/or mortality of
patient management decisions made at the visit where 2 out of 3 elements of MDM determine the overall level

Time-Based Billing: Includes all provider time on the date of
service—face-to-face and non-face-to-face activities such as
reviewing records, documentation, and care coordination.

· Time spent by residents/fellows without the attending does not count.

· Time must occur on the same calendar day.

· Clinical staff time is excluded.

NEW PATIENT E/M SERVICE

Patients being seen for a New Patient E&M service should be scheduled for in-person care.

Exceptions may granted if it is appropriate to provide care to new
patients by telehealth on a case-by-case basis.  For example, if a child is immunocompromised or the household is in quarantine.

By following these guidelines, one can confidently integrate telehealth into their practice while ensuring accurate documentation and compliant billing. Proper use of smart phrases, time tracking, and modifiers not only supports reimbursement but also upholds the integrity of patient care.