Dive Brief:
- A survey released on Tuesday by Epic Research found telehealth visits were more frequently billed as less complex compared to in-person office visits for both primary and specialty providers.
- Telehealth visits were more readily billed with lower level of service (LOS) codes than in-person visits, according to the study. Higher service codes correspond to more complex patient encounters, with LOS 1 being the least complex and LOS 5 the most complex.
- The results indicate patients might self-select in-person office visit over telehealth options if they feel they need a higher level of care. In addition, the proximity of additional tests and services at in-office visits may help providers give additional assessments to “increase the level of service” during care sessions, according to the report.
Dive Insight:
The Epic Research study comes after other research has suggested telehealth visits are more often utilized for less-complex medical visits, like medication management, chronic disease management and existing patient follow-up.
In a survey of LOS codes for over 1 million telehealth visits and over 5 million office visits from Jan. 1, 2022 through June 30, 2023, more than half of primary care telehealth visits for existing patients received lower-complexity LOS 3 coding compared with 43% of in-person appointments for established patients, according to the new study.
Likewise, for new patients, telehealth primary care visits were coded at LOS 3 49% of the time compared with 42% of in-person visits.
Telehealth visits for new and established patients were consistently billed at lower-complexity LOS codes, with the exception of specialty telehealth visits for new patients receiving slightly more LOS 5 visits than in-person visits.
The study noted additional research is necessary to assess what factors may contribute to the differences in coding.
The Epic survey on how providers bill telehealth visits follows a study from KFF published in January that found private insurers paid roughly the same for telehealth and in-person visits during the early days of the COVID-19 pandemic. The findings called into question the argument that telehealth saves the healthcare system money, according to researchers.
