How To Use HCPCS Code G0426

HCPCS code G0426 describes a telehealth consultation service provided in an emergency department or during the initial inpatient visit. This code is typically used when a healthcare provider communicates with a patient via telehealth for approximately 50 minutes. In this article, we will explore the details of HCPCS code G0426, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0426?

HCPCS code G0426 is used to identify a telehealth consultation service provided in an emergency department or during the initial inpatient visit. This code is specifically used when the healthcare provider communicates with the patient via telehealth for approximately 50 minutes. It is important to note that this code is only applicable for telehealth consultations and not for in-person visits.

2. Official Description

The official description of HCPCS code G0426 is “Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth.” The short description for this code is “Inpt/ed teleconsult50.”

3. Procedure

1. The healthcare provider initiates a telehealth consultation with the patient in the emergency department or during the initial inpatient visit.
2. The provider communicates with the patient via telehealth technology, such as video conferencing, for a duration of approximately 50 minutes.
3. During the consultation, the provider assesses the patient’s condition, discusses symptoms, reviews medical history, and provides medical advice or treatment recommendations.
4. The provider may order additional tests or procedures based on the consultation.
5. After the consultation, the provider documents the details of the telehealth consultation in the patient’s medical record.

4. When to use HCPCS code G0426

HCPCS code G0426 should be used when a healthcare provider conducts a telehealth consultation in an emergency department or during the initial inpatient visit. This code is specifically for consultations that last approximately 50 minutes and are conducted via telehealth technology. It is important to ensure that the consultation meets the criteria specified in the code description to accurately use HCPCS code G0426.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0426, healthcare providers need to document the following:

• Date and time of the telehealth consultation
• Duration of the consultation (approximately 50 minutes)
• Location of the consultation (emergency department or initial inpatient)
• Details of the communication method used (telehealth)
• Documentation of the assessment, discussion, and any medical advice or treatment recommendations provided during the consultation

It is essential to maintain accurate and detailed documentation to support the billing of HCPCS code G0426.

6. Historical Information and Code Maintenance

HCPCS code G0426 was added to the Healthcare Common Procedure Coding System on January 01, 2010. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. The code’s pricing indicator code is 13, which signifies that the price for this service is established by carriers based on individual determination and carrier discretion.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the telehealth consultation service represented by HCPCS code G0426. However, coverage may vary depending on the specific policies and guidelines of each insurance provider. It is important to verify coverage and reimbursement requirements with the respective insurance companies.

8. Examples

Here are five examples of scenarios where HCPCS code G0426 should be billed:

1. A patient presents with severe abdominal pain in the emergency department. The healthcare provider conducts a telehealth consultation to assess the symptoms and determine the appropriate course of action.
2. During an initial inpatient visit, a patient experiences a sudden change in their condition. The provider conducts a telehealth consultation to evaluate the change and make necessary treatment recommendations.
3. A patient in the emergency department requires a psychiatric evaluation. The provider conducts a telehealth consultation to assess the patient’s mental health and develop a treatment plan.
4. Following a surgical procedure, the healthcare provider conducts a telehealth consultation with the patient to monitor their recovery progress and address any concerns or complications.
5. An inpatient requires a consultation with a specialist who is not physically present at the facility. The provider conducts a telehealth consultation to facilitate the specialist’s input and recommendations.