TELEMEDICINE & COVID-19
Christopher Heron, MD, FAAFP
BASICS
DESCRIPTION
Use of electronic communication technology to deliver care at a distance, including two-way video conferencing, telephonic technology, and asynchronous video conferencing
PLATFORMS
- • Per the U.S. Department of Health and Human Services, non-public-facing video chat software can be used (e.g. Google Hangouts, Apple FaceTime, etc.). IF video capability is not available, phone only is acceptable.
- • For resources for evaluating telemedicine software, see Additional Reading.
PROVISION OF SERVICE
- • A full history can be obtained as in-person. Physical exam is limited, but can be conducted:
- – Visual assessment of oropharynx, eyes, rashes and lesions, gross joint assessment
- – Physician-guided patient examination of lymphadenopathy, joint range of motion, and special testing, limited cranial nerve exam, cerebellar testing, palpation of masses, gait
- • Balance the risks of overprescribing, excess testing, and patient exposure with need for physical assessment to guide management. If the patient would benefit from a physical exam to provide best practice care, send them for an assessment unless individual circumstances prevent it.
DOCUMENTATION
- • Standard evaluation & management components still required: chief complaint, history of the present illness, review of systems, past medical, family, and social history, exam (if any), medical decision making.
- • Telemedicine documentation requires: the service is synchronous face-to-face telemedicine (phone), authenticating patient identity (name, date of birth), of the location of the provider and patient, consent regarding the use of telemedicine.
- – Example: "After connecting through patient-initiated televideo (or telephone) connection, the patient was verified with two unique identifiers. Patient (or legal representative) was informed that this was a telemedicine visit and that the exam was being conducted confidentially over secure line to my location. Patient acknowledged consent, understanding of billing, privacy and security of telemedicine visit, and gave permission to obtain a history and exam as needed. The patient agrees to participate."
BILLING
- • Patients do not need to be established in your practice to be seen/billed through telemedicine; new patients are allowed.
- • Telemedicine visits with video during the public health emergency can be billed like in-person visits: by components or by time. (Must include total time, >50% of time spent in counseling and/or coordination of care with specific content of that time.)
- • Telemedicine visits without video can use 99441/2/3 based on time (10-minute increments).
- • Medicare Annual Wellness Visits may be done via telemedicine (physical component waived).
ADDITIONAL READING