CTP Documentation and Billing 3 — Questions and Answers
Question 1: A clinician uses an asynchronous store-and-forward method to review dermatology images and send back a diagnosis. Which CPT code category best captures this service?
- 99441–99443 (telephone E/M)
- 99446–99449 (interprofessional telephone/internet consultation)
- Asynchronous store-and-forward codes such as 99453 or specialty-specific codes (Correct answer)
- 99201–99215 (office E/M with Modifier 95)
Correct answer: Asynchronous store-and-forward codes such as 99453 or specialty-specific codes
Store-and-forward asynchronous services use specific codes, such as 99453 for remote monitoring setup or specialty-specific asynchronous codes, not standard synchronous E/M codes.
Question 2: Remote Patient Monitoring (RPM) setup and patient education on device use is billed using which CPT code?
- 99457
- 99453 (Correct answer)
- 99091
- 99490
Correct answer: 99453
CPT 99453 covers the initial setup and patient education on the use of remote monitoring equipment.
Question 3: For RPM monthly management, CPT 99457 requires a minimum of how many minutes of clinical staff time per calendar month?
- 10 minutes
- 20 minutes (Correct answer)
- 30 minutes
- 60 minutes
Correct answer: 20 minutes
CPT 99457 requires at least 20 minutes of clinical staff time per calendar month, including at least one interactive communication with the patient.
Question 4: Which payer-specific modifier should be used instead of Modifier 95 when billing telehealth to Medicaid programs in many states?
- Modifier GT (Correct answer)
- Modifier GQ
- Modifier 93
- Modifier CR
Correct answer: Modifier GT
Modifier GT ('via interactive audio and video telecommunications systems') is commonly required by Medicaid programs and some other payers in place of Modifier 95.
Question 5: A provider conducts a 25-minute video E/M visit and also performs care management for 20 minutes on the same date. How should this be billed?
- Bill both services on the same claim without any modifiers
- Bill the E/M with Modifier 25 to indicate a significant, separately identifiable service (Correct answer)
- Bill only the E/M since care management cannot be billed on the same day
- Combine the time and bill a single higher-level E/M code
Correct answer: Bill the E/M with Modifier 25 to indicate a significant, separately identifiable service
Modifier 25 is appended to the E/M code to indicate it is a significant, separately identifiable service performed on the same day as another procedure or service.
Question 6: In a telehealth documentation note, what information about the technology platform should be included?
- The vendor's HIPAA Business Associate Agreement number
- A statement that HIPAA-compliant audio-video technology was used (Correct answer)
- The IP addresses of both the provider and patient devices
- The software version number of the video platform
Correct answer: A statement that HIPAA-compliant audio-video technology was used
Documentation should include a statement confirming that the visit was conducted using HIPAA-compliant audio-video technology, establishing that privacy standards were met.
Question 7: Which of the following is a key difference between CPT 98966–98968 and 99441–99443?
- 98966–98968 are for video visits; 99441–99443 are for phone visits
- 98966–98968 are for non-physician health professionals; 99441–99443 are for physicians (Correct answer)
- 98966–98968 require a new patient; 99441–99443 are for established patients only
- 98966–98968 are for RPM; 99441–99443 are for chronic care management
Correct answer: 98966–98968 are for non-physician health professionals; 99441–99443 are for physicians
CPT 98966–98968 are telephone assessment codes for non-physician qualified healthcare professionals, while 99441–99443 are the equivalent codes for physicians.
CTP Documentation and Billing 3
A clinician uses an asynchronous store-and-forward method to review dermatology images and send back a diagnosis.
Which CPT code category best captures this service?