March 31, 2020
• Center your Image
• Dress professionally
• Be aware of what your patient can see in the background
• Acknowledge everyone in the room
• Maintain eye contact with the patient
• Don’t eat or drink when you’re on camera
• Describe what you are doing aloud
• Manage your time
Virtual Physical Exam
Gen: sitting up, speaking in full sentences, mood and affect appropriate, no signs of distress
HEENT: Eyes open, no conjunctival erythema, no difficulty swallowing, audible congestion in voice, no lymph node tenderness, no neck stiffness Pul: no SOB, no audible wheezing, coughing during exam Abdomen: no tenderness over the abdomen with patient applied pressure
Extr: able to move all extremities without weakness, normal gait
Skin: no rashes noted
• Can easily see an eye to assess injection, icterus & symmetry
• Instruct patients to move eyes to evaluate extra ocular movements
• Have a patient use a flashlight to evaluate for reactivity
• Visual Acuity can be assessed using eye chart applications which can be downloaded on the phone
Pharyngitis
• Have the patient angle the camera to evaluate tonsils and pharynx
• Ask the patient to feel their lymph nodes for tenderness
• Observe if they cough or have a runny nose
Ankle Pain • Use Ottawa Ankle Rules
• Ask them to demonstrate bearing weight
• Have patient palpate over specific areas of bony tenderness
• If all negative, you have saved patient trip to IC or ED
• You can order x-ray and f/u
Scheduled Video Visits Telehealth Coding Sheet
Straightforward Straightforward Low Moderate High
Medical Decision Making
1 Follow-Up Stable Problem or 1 Self-Limited Problem (e.g., cold, insect bite, minimal lab tests, rest)
1 Follow-Up Stable Problem or 1 Self-Limited Problem (e.g., cold, insect bite, minimal lab tests, rest)
2 Self-Limited Problems, 1 Acute Uncomplicated Illness/Injury, 1 Stable Chronic Illness, OTC meds
Undiagnosed New Problem w/Uncertain Prognosis, Chronic Illness w/Exacerbation, 2+ Chronic Stable Illness, Rx Drug
Life/limb Threatening, Severe Exacerbation of Chronic Condition, Abrupt Change in Neurologic Status
NEW PATIENTS REQUIRE HISTORY, EXAM, AND MEDICAL DECISION MAKING (code to the lowest met requirement of History, Exam, and Medical Decision Making)
1 HPI 1 Organ System Exam
1 HPI, 1 ROS 2-7 Organ System Exam,
Limited
4 HPI, 2 ROS, 1 PFSH 2-7 Organ System Exam,
Extensive
4 HPI, 10 ROS, 3 PFSH 8 Organ System Exam
4 HPI, 10 ROS, 3 PFSH 8 Organ System Exam
New Pt. Office 99201 (10min) 99202 (20min) 99203 (30min) 99204 (45min) 99205 (60min)
Straightforward Low Moderate High
Medical Decision Making
1 Follow-Up Stable Problem or 1 Self-Limited Problem (e.g., cold, insect bite, minimal lab tests, rest)
(A) 2 Follow-up Stable Problems or 1 Follow-Up Worsening Problem, and (B) Low risk category (e.g., 1 Uncomplicated Illness/Injury, OTC meds)
(A) 2 Follow-Up Worsening Problems, 3+ Follow-Up Stable Problems or 1+ New Problems, and (B) Undiagnosed Problem w/Uncertain Prognosis, Chronic Illness Exacerbated, 2+ Chronic Stable Illness, Rx Drug
(A) 2 Follow-Up Worsening/Not Improving Problems, 4+ Follow-Up Stable Problems or 1 New Problem w/Additional Work Up, and (B) Life/Limb Threatening, Severe Exacerbation, Drug Therapy Requiring Intensive Monitoring For Toxicity
ESTABLISHED PATIENTS REQUIRE EITHER HISTORY OR EXAM
1 HPI -or-
4 HPI, 2 ROS, 1 PFSH -or-
2-7 Organ System Exam, Extensive
4 HPI, 10 ROS, 2 PFSH -or-
8 Organ System Exam
Established Patient Office Visit
Use the charge orders that start with "Video Visits..."
Please note that some payers will not cover 99204 and 99205 due to the 8 organ system exam requirement. If billed on time, it should be fine upon appeal.
If there are questions about levels of service, please contact your Professional Documentation and Coding consultant.
Coding/Billing a Telehealth Visit
•Use a GT and/or -95 modifier on the primary code
•Most Plans Place of service = 02
• Place of service 11 for Blue Cross
• If coding up for time element make sure that you are including documentation of time
It is important that you confirm individual payer policies directly with the payer since each payer may have distinct contracts with your clinic/group.
2020 CMS COVID Coverage Changes • HIPAA secure connection temporarily waived for visit platform
• Medicare, Utah Medicaid, Select Health, Blue Cross and others – synchronous covered for all patients regardless of location.
• Remote Patient Monitoring Covered
• Ryan Height Act/DEA Changes
• Anti-Kickback/Beneficiary Inducement OIG Waiver
• LCSW, child psychologists services, physical therapy services, occupational therapy and speech language pathology will be covered via telehealth
2020 CMS COVID Changes (cont.) • Physician supervision requirements can be met through telehealth
• If a physician determines that a Medicare beneficiary should not leave home because of a medical contraindication or due to suspected or confirmed COVID-19, and the beneficiary needs skilled services, he or she will be considered homebound and qualify for Medicare Home Health Benefit
• Virtual Check-In allowed for new patients
• In-patient rehab facility visits allowed
• Waive face-to-face requirements for home dialysis
• Recertification of eligibility for hospice care allowed
The Future of Telehealth Beyond COVID-19?
QUESTIONS?