## Definition
The Healthcare Common Procedure Coding System (HCPCS) code G2250 is used to describe the transmission of a recorded video and/or images to a physician or other qualified healthcare professional. This exchange typically is involved in non-face-to-face communication involving video or digital images that are intended for evaluation. G2250 specifically applies when this transmission is part of a consultation, follow-up, or diagnostic process that does not require a live interaction between the patient and the healthcare provider.
G2250 differs from live telehealth services in that it emphasizes asynchronous communication. This code allows healthcare professionals to review the information at a later time, rather than in real time. It enables a more flexible and convenient exchange of medical data between the patient and the provider, particularly in diagnostic assessments.
## Clinical Context
G2250 is particularly apt for use in dermatological consultations, where a patient may submit images of skin conditions for evaluation, avoiding the need for an in-person visit. It is also utilized in instances where healthcare providers need to examine follow-up scans or images after a procedure. Pathology and radiology are other fields that frequently use this code due to the necessity of reviewing static images outside of a direct consultation.
This code enhances patient-provider communication, especially in remote and underserved geographic locations. It also benefits patients by reducing the number of necessary in-person visits, thus conserving medical resources and adhering to post-pandemic guidelines for minimizing in-person interactions where possible.
## Common Modifiers
Modifiers play a crucial role in conveying additional information about the services billed under G2250. The most frequently utilized modifiers include Modifier 95, which signifies that the service was rendered via synchronous technology, even though G2250 itself is asynchronous. Adding Modifier 95 can be essential when the service is part of a larger telehealth encounter.
Modifier GQ may also be applied, particularly when the services are performed via an asynchronous telecommunications system in locations listed under rural health designations. This modifier relates to telehealth services delivered to patients located in Health Professional Shortage Areas (HPSAs), as determined by federal regulations.
## Documentation Requirements
Accurate and comprehensive documentation is critical when submitting claims for G2250. Providers must clearly document that the patient’s images or video were submitted in a non-face-to-face manner and reviewed accordingly. Documentation should also include the provider’s interpretation of the data and any subsequent clinical recommendations or actions taken.
Healthcare professionals are advised to thoroughly record the time spent reviewing the submitted materials, as this may be pivotal in substantiating the use of the code. Finally, the date of service should reflect when the document or image review was completed rather than when the images were initially transmitted.
## Common Denial Reasons
One common reason for denial of claims under G2250 relates to incorrect or insufficient documentation. If the healthcare provider fails to document that the interaction was conducted asynchronously or neglects to record findings, the claim could be rejected. Additionally, if the provider does not submit appropriate modifiers, such as GQ or 95, the claim might not meet local payer guidelines and result in denial.
Denials may also occur if the service is provided for a condition that is not deemed appropriate for virtual review, such as an emergency that necessitates real-time intervention. Lastly, services provided via G2250 may be denied when billed by healthcare providers in non-eligible geographical areas, or when commercial insurers consider the service unnecessary or duplicative.
## Special Considerations for Commercial Insurers
Commercial insurers often have their own sets of rules concerning the interpretation and reimbursement of HCPCS codes like G2250. Some insurers take a more conservative approach and do not recognize G2250 if the virtual exchange does not meet their predetermined criteria for medical necessity. Therefore, it is essential to pre-verify coverage for telehealth and asynchronous services with each insurer.
Providers should be aware that coverage may vary widely depending on the state, as insurance companies might follow local guidelines rather than broader federal mandates. Certain insurers may require separate prior authorizations, particularly if the service involves a high-cost specialty such as radiology or cardiology review.
## Similar Codes
Several other HCPCS and Current Procedural Terminology codes are closely related to G2250 and may be appropriate for different forms of telecommunication services. For instance, G2010 is another code that covers the remote evaluation of recorded video and/or images, but it is limited to the determination of whether an in-person visit is needed within 24 hours. This makes G2010 distinct from G2250, which is used more broadly for ongoing consultations involving stored data.
Likewise, HCPCS code G2251 applies to brief communication technology-based services, such as telephone and video interactions, but largely relates to real-time (synchronous) communications. Comparatively, G2252 is used for extended medical discussions beyond the typical time length, but it does not specifically focus on asynchronous transmission of images as G2250 does. Each of these codes occupies its own niche within the evolving domain of telehealth-based healthcare services.