Telehealth continues to have value outside of pandemic
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ORLANDO – The COVID-19 pandemic forced many clinicians to adopt telehealth for their practices, but Christopher Wolfe, OD, in his presentation here at Vision Expo East, urged optometrists to continue using the technology even now that their offices have reopened.
Telehealth allows clinicians to be available 24 hours a day without necessarily having to go into the office, he said.
“At the beginning of the pandemic, we were instructed not to provide urgent or emergent care over telemedicine,” Wolfe said. “In our practice we limited our hours physically, 8 a.m. to 2 p.m.”
Wolfe said he was faced with, “taking a phone call at 10 p.m., opening the office and finding the patient’s file, with me being the only person in the office late at night and potentially with a female. Do I bring one of my kids? Or do I handle it over the phone and not get paid for it?
“Now I have this intermediate step, which is crazy how wonderful it is,” he continued. “I can take a 10 p.m. phone call and say, ‘Let’s jump online and see if I need to see you now or in the morning.’ I can see how much pain and concern the patient has.”
Wolfe urged clinicians to consider using telehealth frequently.
“If a patient calls me now, I can do telehealth or schedule them to come into the office,” he said. “Think about this as a way of being available to your patients all the time.”
Telehealth visits are reimbursed at the same rate as in person, Wolfe said. Codes are 99201 to 99215 for new and established patients, with -95 modifiers.
Outside of the pandemic, real-time audio and video communications are required, he said. He recommended using Doxy.me, Eyecare Live, FaceTime or Skype.
Other options include a non-face-to-face, patient-initiated communication through an online portal and captured video/images sent to the physician. Different codes are used for these situations.
Wolfe shared an example of a phone call with a patient who was seen in the office 1 month prior. He was diagnosed with allergies and prescribed an allergy medication twice a day. The call lasted 5 to 10 minutes, and Wolfe recommended altering the dosing because the patient was feeling good, with a follow-up evaluation in the fall.
This visit should be coded as G2012, Wolfe said. If it were done through captured video and sent to the physician by the patient, the code would be G2010. If the visit were performed through a patient portal and done via text, the code would be 99421. And if done through real-time audio and video, the code would be 9921x.
Wolfe shared another telemedicine visit with a patient who wore scleral lenses and complained of dry, gritty eyes, no light sensitivity and no purulent discharge.
“I got great images through Doxy.me,” he said. “I needed to determine if it was a fit issue or an ocular surface issue. I was able to enlarge the image so much that I could see the reflection of his wife in the lens. I got the patient to take multiple photos with the lid lifted and different directions of gaze.
“You can get really good images this way if it’s clinically appropriate to manage the patient.,” he added.
Wolfe summarized potential revenue based on Medicare national averages: Service G2012, $12; 99212, $54.20; 99213, $86.78; 99214, $122.91; and 99203, $106.14.
“If we delivered all of this care just in a week, that’s $18,000 per year,” he said. “It helped support us through the pandemic.”
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Wolfe C. Practical implementation of telehealth: COVID and beyond. Presented at: Vision Expo East; Orlando, Fla.; June 2-5, 2021.
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