January 2023 AI Alert

Coding and Billing for Audio-Only Delivered Services using Modifier 93

The healthcare industry has experienced significant growth and adoption of telehealth services over the past several years, and with it, a new trend of delivering audio-only services to patients.

The 2023 CPT manual, American Medical Association (AMA) version, has listed all of the correct codes to be billed with the modifier 93 in Appendix T, page 1,042. There is a new symbol, = to indicate this is audio-only which appears next to the codes in the CPT manual for the codes in which it applies.

As of January 1, 2022, the use of Modifier 93 became effective, allowing the reporting of medical services that are provided via real-time interaction between the physician or other qualified healthcare professionals and a patient through audio-only technology. Modifier 93 is utilized to report synchronous telemedicine services when rendered via the telephone or another real-time, interactive audio only, telecommunications system. The interaction takes place between the physician, or other qualified healthcare professionals, and the patient, who is at a distant site (i.e., rural location) from the healthcare provider. The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

Using Codoxo’s Fraud Scope Query Builder to Assess Improper Modifier 93

1. Select Query, Query Builder [Professional, Lines]
2. Click Modifier from the filters, choose, Exact and input 93
3. Client Provider Payment Received, Minimum $1
4. Click Search

Compare the codes that were billed with Modifier 93 to those in Appendix T and assess against your respective health plan and line of business policy manuals.

Suspicious Trends to Monitor:

• • If used with an evaluation and management code, the modifier has been used incorrectly. Instead, append the 95 modifier or use the appropriate telehealth telephone code.
  • Look for other services billed for the same patient and/or same date of service, such as lab tests or other procedures billed by the same provider
  • Excessive use or high-volume utilization of modifier 93
  • Determine if it makes sense for the area where the patient lives, is it rural, etc.?
  • Billing for multiple family members on the same date of service by the same provider with all services being rendered with the 93 modifier. Inquiring about the rest of the patient’s family does not equate to a billable service. The healthcare provider would need to speak with each patient.

If you are interested in learning more about Codoxo’s forensic AI platform or would like to speak to Codoxo team member, contact us via info@codoxo.com.

References:

1. American Medical Association- Full Modifier Definition
   https://www.ama-assn.org/system/files/cpt-appendix-a-modifier-93.pdf

2. American Medical Association- Table
   https://www.ama-assn.org/system/files/cpt-appendix-t.pdf