Summary & Overview
HCPCS G0407: Follow-Up Inpatient Consultation, Intermediate
HCPCS Level II code G0407 denotes an intermediate follow-up inpatient consultation delivered via telehealth, typically involving about 25 minutes of physician-patient communication. This code identifies a specific telehealth inpatient service line that supports continuity of care after an initial inpatient assessment or procedure and is relevant for hospitals, telemedicine programs, and clinicians documenting inpatient virtual consults. Nationally, accurate use of this code affects clinical documentation, claims processing, and encounter-level data for inpatient telehealth services.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns and documentation expectations where available and highlights implications for inpatient telehealth billing.
Readers will find: a concise description of the service and typical site of service; a summary of common modifiers used with inpatient telehealth consultations (input provided); benchmarking context and payer coverage overview where available; and clinical context to support appropriate coding and documentation. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and specific payer policy details are noted as unavailable.
Billing Code Overview
HCPCS Level II code G0407 describes a follow-up inpatient consultation, intermediate, provided via telehealth with physicians typically spending 25 minutes communicating with the patient.
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Service type: Follow-up inpatient consultation, intermediate
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Typical site of service: Inpatient (telehealth communication with the patient)
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male hospitalized for acute exacerbation of congestive heart failure is seen on hospital day three for a follow-up inpatient consultation by a cardiology consultant via telehealth. The consultant documents an interim assessment, adjusts diuretics, reviews laboratory and imaging results, and communicates recommendations to the attending physician and the patient/family. The consultant spends approximately 25 minutes in synchronous audio-video telehealth communication with the patient and documents medical decision-making supporting the follow-up visit.
Typical clinical workflow:
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The primary team places a consult request for cardiology follow-up.
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The cardiology consultant reviews the chart, labs, imaging, and prior consultation notes.
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The consultant conducts a synchronous telehealth encounter with the patient (and caregiver as needed), documents history update, focused exam via video, assessment, and plan, and communicates recommendations to the attending team.
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The consultant documents time spent in the medical record, signs the consult note, and the facility billing office appends the appropriate billing code and modifier(s) before claim submission.
Coding Specifications
| Modifier | Description | When to Use |
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