How to Get Started with Telemedicine
- Decide where you will be conducting telehealth visits: home or office. If conducted in your office, a technician can take the history and ensure that the visual acuity is checked.
- Decide how long your telehealth visits will be. At least 20 minutes is recommended.
- Decide the parts of the exam to include in the visit and the types of complaints that are feasible for telehealth consultation. to include in the visit.
- Visual acuity testing is ideally performed prior to the telehealth visit.
- The office or the physician initiates contact with the patient via the chosen medium and requires a smartphone or computer with a camera. Document the medium used.
- Document the visit in your medical record as you normally would, as well as documenting the start and end times of the encounter and that the patient/parent gave verbal consent for the telehealth encounter to proceed.
- Code the visit using E/M codes only. Place of service is 02, and modifier -95 is used designating the service as telehealth.
- For a telehealth E/M code, an exam is not necessary.
- For established patients, history and medical decision-making can be used as the two key components. Time spent can also be used.
- For new patients and consultations, 3 key components are required. If a physical exam is not performed, the visit is coded by time spent.
- Coding by time spent means that counseling and/or coordination of care represented more than 50% of total face-to-face time, which should also be reflected in the medical record. A time state is also required, such as I spent ____ minutes face-to-face with patient and/or family via real-time audio-visual telehealth dominated by counseling and coordination of care.
Visits to the Office:
- Limited to urgent issues and emergencies which include trauma, chemical exposure, cataract, glaucoma, sudden change in vision, floaters/flashing lights, corneal abrasions, eye pain. ROP exams also continue on schedule.
- For pediatric patients, families are encouraged to come with one parent and the patient only, leaving siblings and the other parents and grandparents at home. Screen those coming into the office with questions and consider using a non-contact thermometer to take their temperature.
- For the time being, rescheduling of non-urgent follow-up visits is no earlier than May 2020 with the understanding that this may change.
Glasses/Contact Lenses:
Consider extending the expiration date of prescriptions by 3-4 months.