decisionhealth Newsletters, Coder Pink Sheets - 2022 Issue 8 (August)
Confirm medical necessity of same-day telehealth and in-person encounters
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Article Overview
This article explains how same-day telehealth and in-office encounters can arise during the COVID-19 public health emergency and why these situations may draw auditor attention. It focuses on the documentation, medical necessity, and diagnosis-linking concepts that help show the in-person service was prompted by information learned during the telehealth visit. The guidance is aimed at clinicians, coders, and billing staff handling evaluation and management services across telehealth and face-to-face settings.
Why This Topic Matters
Same-day telehealth and office encounters can create questions about whether services are separately supportable and well documented. Understanding the general compliance and documentation issues helps practices reduce audit risk and support claims appropriately.
What You Will Learn
- Why same-day telehealth and in-person encounters may occur more often during the COVID-19 public health emergency
- What kinds of documentation should support the need for a follow-up in-person visit after telehealth
- Why repeated telehealth-to-office patterns may attract auditor scrutiny
- How diagnosis linkage is discussed as part of supporting medical necessity
Who Should Read This
- Coders
- Billing staff
- Compliance staff
- Physicians and other treating practitioners
- Practice managers
Modifiers Discussed
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