Telehealth visits frequently billed at lower level of service vs. those in office
Key takeaways:
- More primary care office visits were billed at LOS 4 than telehealth visits.
- Physicians can expect telehealth visits to be generally less complex, according to a researcher.
Telehealth visits were more often billed at a lower level of service compared with office visits in both primary and specialty care, a recent report from Epic Research showed.
“In June, we published a study that showed follow-up rates for telehealth encounters tended to be lower than follow-up rates for in-office visits,” Kersten Bartelt, RN, a clinician at Epic Research, told Healio. “In the current study, we wanted to understand if [level of service (LOS)] helped us better understand the type of care patients were receiving via telehealth.”
To do this, Bartelt and colleagues evaluated LOS billing codes for 1,313,724 telehealth visits and 5,254,896 office visits from Jan. 1, 2022, through June 30, 2023.
LOS codes ranged by the complexity of patient encounters on a scale of 1 to 5, with 1 being the least complex and 5 the most complex. Meanwhile, patients in both the telehealth and office cohorts were matched by several factors, including race, sex, age and whether they were a new or established patient.
The researchers found that in primary care, visits coded at LOS 3 or 4 were the most common.
Overall, 53.7% of primary care telehealth visits for established patients were coded at LOS 3 vs. 43.3% of primary care office visits. However, only 40.8% of primary care telehealth visits for established patients were coded at LOS 4 vs. 52.5% of primary care office visits.
The researchers noted that LOS 4 was the most frequent code for both telehealth and office visits in specialty care.
A total of 64.1% of specialty care office visits for established patients were coded at LOS 4 or 5 compared with 56.8% of specialty care telehealth visits.
Notably, new patients in specialty care were billed at LOS 5 in telehealth visits more frequently than in-office visits.
In both primary and specialty care, telehealth and office visits billed at LOS 2 were higher for new patients than established patients.
Bartelt noted that although the lower LOS in telehealth visits lined up with the researchers’ expectations heading into the study, “new patients having higher rates of LOS 2 than established patients was a surprise, as this may indicate a less thorough appointment for new patients than established ones.”
Ultimately, “primary care physicians can expect their telehealth encounters to be less complex than their in-office visits,” she said. “Additional research could explore a patient’s ability to access services to see how age, location, or other demographics factor into the selection of either type of service.”
Perspective
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I’m not sure that the differences the authors are citing are statistically relevant. It’s a descriptive study, and if you look for instance at patients in primary care, the difference between 5.6% of new patients in the office at the lowest LOS and 10.7% of telehealth patients at the lowest LOS… It may or may not be real. I see that across all of the categories, it’s consistent, but they’re not big differences.
With that caveat, the study really brought to mind for me a couple of phenomena. There’s only so much we can do on a video call. It is limited. The way we code evaluation and management services is by the complexity of decision-making, and I think it’s not too surprising that clinicians using telehealth would probably conclude that their decision-making was less complex on a video call than in an office setting, maybe because in an office setting you have more data inputs and maybe you’re saving the more complicated patients for office visits.
It's a two-sided situation. It’s not a failing of telehealth that people are billing lower codes, but it’s mostly likely that clinicians are finding the right triage path for the patients that need perhaps less intensive service offerings that can be done by video.
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Telehealth visits frequently billed at lower level of service than office visits. https://epicresearch.org/articles/telehealth-visits-frequently-billed-at-lower-level-of-service-than-office-visits. Published Sept. 12, 2023. Accessed Sept. 13, 2023.
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