The growth in use and availability of virtual care services has expanded access for individuals, especially for those without a regular source of care. The medical coding infrastructure should be updated and modernized to incorporate these new modalities.
National standardized code sets are used to report medical diagnoses, tests, services, and procedures on healthcare claims. The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association and used to report services delivered by physicians and other providers. Coding systems evolved quickly to keep pace with innovations and flexibilities adopted during the COVID-19 pandemic. However, this analysis conducted by HMA and funded by the Elevance Health Public Policy Institute shows that further expansion of the code sets is warranted.
In particular, gaps could be addressed in two ways. Create a set of time-based e-visit codes for patients without an existing provider relationship and add a unique modifier code to report that care was rendered via secure short messaging services (SMS) communication.
- Growth in Use of Virtual Care
- Coding for Virtual Care Services
- Innovation & Gaps in Coding
- New Patient Relationships