CTP Documentation and Billing 4

Question 1

What is the primary purpose of documenting the 'chief complaint' in a telehealth SOAP note?

Accepted Answer

To establish medical necessity for the level of service billed

Answer

The chief complaint is fundamental to establishing medical necessity, which payers require to justify the billed E/M level for any service including telehealth.

Question 2

A telehealth claim is submitted with the wrong Place of Service code. The payer denies it. What is the FIRST step the biller should take?

Accepted Answer

Correct the POS code and resubmit the claim within the payer's timely filing window

Answer

Administrative denials for coding errors like wrong POS codes are typically correctable by resubmitting with the accurate code, provided it is done within the payer's timely filing deadline.

Question 3

Under CMS guidelines, which of the following patient locations was traditionally NOT eligible as an originating site for Medicare telehealth before COVID-19 waivers?

Accepted Answer

The patient's own home (for non-end-stage renal disease patients)

Answer

Prior to COVID-19 PHE waivers, the patient's home was generally not an approved Medicare originating site; patients had to travel to an approved facility in a rural area.

Question 4

Which documentation element helps differentiate a new patient telehealth visit (99202–99205) from an established patient visit (99212–99215) when audited?

Accepted Answer

Evidence that no professional service was provided by the provider or group in the past 3 years

Answer

A new patient is defined as one who has not received a professional service from the provider or any other provider of the same specialty in the same group within the past 3 years.

Question 5

A provider bills a 30-minute psychiatric telehealth session. Which CPT code family is most appropriate?

Accepted Answer

90832–90838 (psychotherapy add-on codes)

Answer

CPT 90832 (30 minutes) is part of the psychotherapy codes used for interactive complexity sessions, appropriate for a 30-minute psychiatric therapy telehealth visit.

(CTP) Certified Telehealth Practitioner Practice Test

(CTP) Certified Telehealth Practitioner Practice Test

CTP Documentation and Billing 4