Blog: How the AMA is hatching new billing codes for telemedicine

The American Medical Association is playing catch-up to the already explosive growth in telemedicine, according to physicians involved in the AMA's new work group tasked with cranking out billing codes for the technology-enabled encounters.

Telemedicine “is not going to be a replacement” for traditional face-to-face physician-patient encounters, but will be “another avenue and another channel” for reaching patients, said Dr. Frank Dubeck, one of four co-chairpersons of the CPT Telehealth Services Workgroup, whose members met face to face for the first time last week in Philadelphia.

The work group reports to the AMA's CPT Editorial Panel, which creates and curates the Common Procedural Terminology code system used for billing of physician services.

Dubeck is also a member of the executive committee of the AMA's CPT Editorial Board, which oversees the CPT coding system.

Telemedicine is here and is likely to grow with the addition of millions of recently insured patients under the Affordable Care Act, said Dubeck, an internist and chief medical officer for medical policy and clinical editing at Excellus BlueCross BlueShield, Rochester, N.Y.

“The sky's the limit,” Dubeck said. “What's happening with the advancement in technology (is) the current code set is not meeting the needs of provider, vendors and payers."

Another telehealth driver is the demand for healthcare services by self-funded employer groups.

“They want their employees to be at work,” Dubeck said, and telehealth visits help make that happen. Private payers, meanwhile, have small-scale pilots of potentially beneficial telehealth services.

The AMA has dozens of CPT codes for face-to-face patient encounters that can be bootstrapped into service to bill Medicare for telemedicine procedures by adding a “GT” modifier. But there are many more telehealth services, particularly in the area of bundled payments for patient-centered care, in which additional codes will be needed, said work group co-chair Dr. Barbara Levy.

“We need to be able to have a code set that captures that,” said Levy, vice president for health policy at the American Congress of Obstetricians and Gynecologists. Levy, one of Modern Healthcare's 50 Most Influential Physician Executives and Leaders in 2015, is past chairwoman of the AMA's specialty society relative value scale update committee, better known as “the RUC,” which calculates the expense associated with thousands of physician services linked to CPT codes. She now serves on the CPT editorial panel.

The next order of business for the work group is to sort itself into subgroups, get oriented to some future telehealth possibilities and triage the existing telemedicine use cases to determine those in most immediate need of codes and then produce code recommendations as soon as possible for the editorial board.