CTP Documentation and Billing 2 — Questions and Answers
Question 1: Which modifier is appended to a CPT code to indicate a telehealth service was provided via audio-visual technology?
- Modifier 95 (Correct answer)
- Modifier GT
- Modifier 25
- Modifier 59
Correct answer: Modifier 95
Modifier 95 indicates synchronous telemedicine services rendered via real-time interactive audio and video telecommunications.
Question 2: A telehealth provider sees a patient for the first time via video. What level of documentation is required compared to an in-person new patient visit?
- Reduced documentation is acceptable for telehealth new patients
- The same history, exam, and medical decision-making standards apply (Correct answer)
- Only the chief complaint and plan need to be documented
- A telephone encounter note template is sufficient
Correct answer: The same history, exam, and medical decision-making standards apply
Documentation requirements for telehealth new patient visits mirror those of in-person visits, including history, exam elements performed, and medical decision-making.
Question 3: Which element MUST be documented in every telehealth encounter note to support billing?
- Patient's insurance ID number
- Confirmation that the patient provided verbal or written consent for telehealth (Correct answer)
- The brand of video platform used
- The patient's exact GPS location
Correct answer: Confirmation that the patient provided verbal or written consent for telehealth
Documentation must confirm patient consent to the telehealth visit, as consent is a billing requirement under CMS and most state regulations.
Question 4: Under Medicare rules, what is the role of the 'originating site' in telehealth billing?
- It is the location where the rendering provider physically sits
- It is the patient's physical location during the telehealth visit (Correct answer)
- It is the billing entity that submits the claim
- It is the server location of the HIPAA-compliant platform
Correct answer: It is the patient's physical location during the telehealth visit
The originating site is where the patient is located during the telehealth encounter, and it may be eligible for a facility fee under Medicare rules.
Question 5: A patient calls in for a phone-only visit and does not have video capability. Which CPT codes are most appropriate for a 15-minute telephone E/M service?
- 99201–99205
- 99441–99443 (Correct answer)
- 98966–98968
- 99421–99423
Correct answer: 99441–99443
CPT codes 99441–99443 describe physician telephone E/M services lasting 5–10, 11–20, and 21–30 minutes respectively.
Question 6: When a telehealth visit is conducted across state lines, which state's billing regulations typically govern the claim submission?
- The state where the provider is licensed and located
- The state where the patient is located (Correct answer)
- Federal CMS rules override all state-specific rules
- The state where the billing entity is incorporated
Correct answer: The state where the patient is located
Payer rules and licensure requirements are generally governed by the state where the patient is physically located at the time of service.
Question 7: Which of the following scenarios would most likely result in a telehealth claim denial due to place of service (POS) code error?
- Using POS 02 for a video visit to a patient at home
- Using POS 10 for a video visit to a patient at home
- Using POS 11 for an in-person office visit
- Using POS 02 for a video visit to a patient in a hospital outpatient clinic (Correct answer)
Correct answer: Using POS 02 for a video visit to a patient in a hospital outpatient clinic
POS 02 is for telehealth services provided to patients NOT in their home; POS 10 was introduced for telehealth when the patient is at home, so mixing these creates claim errors.
CTP Documentation and Billing 2
Which modifier is appended to a CPT code to indicate a telehealth service was provided via audio-visual technology?