Primary care telehealth visits coded lower than in-office visits

Primary care telehealth visits coded lower than in-office visits: ©Yurii Maslak - stock.adobe.com

A study from Epic Research shows that telehealth visits are often coded lower than similar in-office visits.

For primary care, researchers found that both telehealth and office visits were most often coded with a Level Of Service of three or four. However, more than half (53.7%) of primary care telehealth visits for established patients were coded LOS 3 compared to 43.3% for office visits. For LOS 4, only 40.8% of telehealth visits received this designation compared to 52.5% for office visits for established patients.

The research was an attempt to better understand the level of care provided through telehealth versus office visits. Researchers evaluated LOS billing codes for 1.3 million telehealth visits and 5.3 million office visits from Jan. 1, 2022, through June 30, 2023. Patients in both in-office and telehealth cohorts were matched by age, sex, race, ethnicity, social vulnerability index, census region, rural or urban area, specialty, chief complaint, and whether the patient was new or established.

Specialty care followed a similar pattern to primary care. Both telehealth and office visits for established patients were coded LOS 4 most frequently. But for specialty care, 64.1% of specialty office visits were coded LOS 4 or 5 compared to 56.8% of specialty telehealth visits. For new patients, similar trends were observed for both telehealth and office visits for both primary and specialty care.

Overall, telehealth visits were consistently billed at a lower level of service than office visits of the same type, with one exception. New patient specialty telehealth visits were billed at LOS 5 slightly more frequently than office visits of the same type, according to the report.

Researchers noted that patients might self-select into an in-person office visit if they feel they need a higher level of care, or the proximity of additional tests, services, and providers in an office setting might help a provider facilitate additional assessment that might increase the level of service provided during the visit.