The 7 day rule for telehealth is a Medicare guideline for virtual check ins and online E/M services, which state that these brief digital communications are generally not billable separately if they relate to an in person visit within the previous 7 days or lead to one within the next 24 hours or soonest available.
The 7 day rule for telehealth is a rule that ensures that these digital interactions are not billed separately when they are a part of the bundled post service work for an established visit, but rather for unrelated issues or new concerns, which allows for separate payment for new digital E/M services.
The key aspects of the 7 day rule for telehealth include.
For Virtual Check-ins (Codes like G2010, G2012, 98016).
It must be patient initiated.
It must not be related to a medical visit in the last 7 days.
And it must not lead to an in person visit in the next 24 hours or soonest appointment.
For online digital E/M services with codes like 99421-99423.
It must be patient initiated and for an established patient.
Must be for an unrelated problem.
And no face to face telemedicine visit within the 7 days after the digital service.
The reason why the 7 day rule for telehealth is important and matters is due to bundling and unrelated issues.
The 7 day rule for telehealth prevents providers from billing twice for care related to the same issue, as normal post visit follow up like answering questions, managing minor issues is bundled into original evaluation and management or E/M service.
And it also creates a pathway to bill for genuinely new digital interactions, like a patient reporting a new rash through portal, not related to their recent physical that require medical decision making.
If a patient calls about something that is related to the telehealth visit they had last week, it's part of that visit's payment.
If they message about a new problem that does not need an immediate in person follow up, then that's a separate, billable telehealth service under the 7 day rule framework.