• SMO

Telehealth- Should you shift?

This post is based on a single Military Treatment Facility (MTF) to provide guidance regarding telehealth appointments. Your local requirements and MTF regulations may differ. You are encouraged to discuss proper documentation and coding with your local MTF officials.

Communication & Documentation

The procedure is:

  1. Review the patient's chart, images etc.

  2. Call Patient

  3. Verify patient’s information at the start of the visit. For high acuity visits, verify patient location in case of emergency.

  4. Make sure at some point to explain the COVID-19 issue briefly and that they will likely not be seen for some time (Be vague).

  5. Obtain verbal consent to conduct the visit telephonically. Example: Hello sir/ma’am. I am Dr. (Name) from (facility). Due to the current situation surrounding the COVID-19 national crises, we are unable to see patients in our normal outpatient clinic. In order to continue carrying for patients, we would like to conduct an outpatient visit over the phone. Is it ok if we discuss your health concerns today?

  6. Create a clinical encounter

  7. Put cursor over appointments under folder on left had column, click on new apt.

  8. Click on SPEC

  9. For reason/subject say “Covid 19 VH”

  10. Document

  11. Telephonic visit

  12. Document as normal for the appropriate encounter type (not in t-con module). Document HPI, PMH, etc. Document assessment and plan. Document VH attestation. Document date and time of encounter (This is apparently important)

  13. Include time spent during the encounter if required by service performed.

  14. Assign the diagnosis(es) as appropriate.

  15. Assign G2012 in the procedure (Healthcare Common Procedure Coding System (HCPCS)) code section.

  16. Assign E/M 99499 or leave blank.

  17. Synchronous Visual and Audio Telecommunication

  18. Document as normal for the appropriate encounter type (not in t-con module). Document HPI, PMH, etc. Document assessment and plan. Document VH attestation. Document date and time of encounter (This is apparently important)

  19. Include time spent during the encounter if required by service performed.

  20. Assign the diagnosis(es) as appropriate.

  21. Assign any procedure performed and documented.

  22. Assign appropriate Evaluation and Management (E/M) service if performed, otherwise assign 99499 or leave blank.

  23. Apply virtual encounter modifier to encounter (GT=MTF to MTF, or 95=provider to patient location other than MTF)

  24. Internal processes to account for patient follow-up needs are essential to quality patient care and extra attention is recommended during this critical time.

  25. Examples of Attestation: Phone Visit Consent and Attestation Documentation: This visit was completed via telephone due to the restrictions of the COVID-19 pandemic. All issues as below were discussed and addressed but no physical exam was performed due to the limitations of an audio-only modality. If it was felt that the patient should be evaluated in clinic or in an emergency room setting then they were directed there. Patient identification was verified at the start of the visit, including the patient’s telephone number and physical location in case of emergency. Patient verbally consented to visit and demonstrated an understanding of the limitations of this virtual visit.

  26. Video Visit Consent and Attestation Documentation: This visit was completed as a virtual video visit using a synchronous, two-way, audio-video telehealth technology platform. Due to the restrictions of the COVID-19 pandemic, a virtual appointment is the preferred method of medical assessment whenever possible. All issues as below were discussed and addressed. Due to the nature of a video-only modality, the only components of a physical exam that could be done are the elements supported by direct visual observation. If it was felt that the patient should be evaluated in clinic or in an emergency room setting then they were directed there. Patient identification was verified at the start of the visit, including the patient’s telephone number and physical location in case of emergency. Patient verbally consented to visit and demonstrated an understanding of the limitations of this virtual visit.

  27. Phone Time Documentation: Spent X minutes with patient on phone discussing health concerns.

  28. Video Time Documentation: Spent X minutes with patient face to face (via video platform) and more that 50% of this time was spent in counseling and coordination of care.


Clinic and Surgery

Resource: https://www.entnet.org/content/new-recommendations-regarding-urgent-and-nonurgent-patient-care


Based on the most current compilation of information, the American Academy of

Otolaryngology–Head and Neck Surgery is recommending that all otolaryngologists limit

providing patient care activities to those individuals with time-sensitive, urgent, and emergent

medical conditions.

The above statement is re-iterated multiple times within the document.

During in-office examinations, topical medications are more safely applied using pledgets rather

than by spray. Surgical procedures should be performed only after ascertaining the COVID-19

status and if positive performed only with PAPR.

BLUF

● Delay all elective ambulatory provider visits

● Reschedule elective and non-urgent admissions

● Delay inpatient and outpatient elective surgical and procedural cases

● Postpone routine dental and eyecare visits

● If you must anesthetize the upper airway for exam pledgets or cotton soaked with

medication may pose less risk of aerosolization.


#SMO #COVID19 #telehealth


Disclaimer: The information provided is designed to provide helpful information on the subjects discussed. The publisher and author are not responsible for any health needs and are not liable for damages or negative consequences from any treatment, action, application or preparation, to any person or person reading or following recommendations and or instructions in this course. References are provided for informational purposes only and do not constitute an endorsement of any sources.

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