Telemedicine

[cowboydoc]

i have been told that we have to bill using time spent. that means 25 minutes for a 99214. it is tough for me to talk to a patient for 25 minutes. i suspect i am getting some bad info from my billers. any thoughts?

Dial slower.

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[ateria radicularis magna]

i have been told that we have to bill using time spent. that means 25 minutes for a 99214. it is tough for me to talk to a patient for 25 minutes. i suspect i am getting some bad info from my billers. any thoughts?

Bad info

 

[PMR2008]

Not true. You can choose to bill time but our 160 providers are billing normal visits and the billing departments converts them to telemed codes at the bac end.

 

[Doctodd]

New guidance on PT and Telehealth



PT can now be included in Telehealth. The PT can only bill the (lower reimbursing codes ) it can be either phone or video and phone



G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes


G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes


G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.





You can only bill one code per patient over 7 days, so if you are doing multiple sessions wait till you surpass 21 minutes of total time ad bill G2063, us place of service code 02 and the G modifiers in the spreadsheet below (thank you Skyler)

Plan:​	Aetna​	Avmed​	BCBS​	Cigna​	Humana​	Medicare​	Preferred Care / Medica​	Simply Health​	UHC Commercial​	UHC Medicare Adv.​
​	​	​	​	​	​	​	​	​	​	​
Modifier Requirements:​	Requires GT Modifier​	Requires GT or 95 Modifier​	Requires GT or 95 Modifier​	Requires GT or 95 Modifier​	None​	None​	​	None​	Requires GT & 95 Modifiers​	Requires GT Modifier​
​	​	​	​	​	​	​	​	​	​	​
POS​	2​	2​	2​	2​	2​	2​	2​	2​	2​	2​
​	​	​	​	​	​	​	​	​	​	​
​	​	​	​	​	​	​	​	​	​	​
Other Notes:​	​	​	Confirmation of coverage via BCBS rep on 3-18-20​	​	​	​	​	​	​	​
​	​	​	​	​	​	​	​	​	​	​
​	​	​	​	​	​	​	​	​	​	​
​	​	​	​	​	​	​	​	​	​	​
​	​	​	​	​	​	​	​	​	​	​
​	​	​	​	​	​	​	​	​	​	​
​	​	​	​	​	​	​	​	​	​	​
GT stands for Via interactive audio and video telecommunications systems
Modifier -95 Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System

 

[DOctorJay]

i have been told that we have to bill using time spent. that means 25 minutes for a 99214. it is tough for me to talk to a patient for 25 minutes. i suspect i am getting some bad info from my billers. any thoughts?

I’m documenting the time I’m spending as well and letting them sort it out. I agree 25 minutes is long.


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[lobelsteve]

i have been told that we have to bill using time spent. that means 25 minutes for a 99214. it is tough for me to talk to a patient for 25 minutes. i suspect i am getting some bad info from my billers. any thoughts?

You were told wrong info.

 

[rexed]

i have been told that we have to bill using time spent. that means 25 minutes for a 99214. it is tough for me to talk to a patient for 25 minutes. i suspect i am getting some bad info from my billers. any thoughts?

Back in the day we could spend hours on the phone, just need to be a smooth talker! Remember when we used to pay by the minute?
(image from New Girl)

 

[trunksvegeta]

Hey guys. I am in the process of setting up my EMR which wont be live until 5/2020. I am enrolled in several insurane panels now but waiting on the EMR which has billing incorporated with it.

Is there a platform that would allow me to see patients telemedicine with encompassed EMR I can use in the meantime for new patients ? Does Doxy me integrate with EMR/insurances?

Thanks !

 

[BobBarker]

Doxy can collect payments through a separate company called stripes but doesn’t really integrate into an emr. You can share screen though if you want to show some imaging or other information to the patient.

 

[Doctodd]

takes a bit of time to review the chart, review previous notes, review imaging studies and labs, etc

 

[lobelsteve]

A Message from Nevro Professional Education In an effort to help support our customers through these rapidly changing times, we are supporting societal education efforts as well as developing educational initiatives aimed at the situation created by the COVID-19 pandemic. As part of our educational programs, we will be launching a series of webinars led by physicians and other health care experts providing practical advice for delivering ongoing patient care. One of the more significant changes over the past few weeks has been around telemedicine. Since this topic is so important to how many physicians are now practicing, the first webinar event will focus on telemedicine and is titled: Practical Telemedicine Today Dr. Jordan Tate, Dr. Paul Lynch, and Dr. Tory McJunkin will be presenting some practical tips and advice on how to best use various platforms for virtual patient visits, including an example of a new patient workup for SCS. Agenda An Overview of Changes in Telemedicine Practical Platforms & Workstations Workflow & Encounters Case Study: Physical Exam & Documentation Q & A When: Tuesday, March 31st Time: 6:00PM Eastern US and 6:00PM Pacific US The webinar will be presented through Zoom at two separate times. Please see the links below to register for one event. Click here to register for the 6:00 PM Eastern US Time Click here to register for the 6:00 PM Pacific US Time Should you have any questions, please contact your local Nevro support team. Thank you for all you are doing to maintain care for your patients and we hope you are able to join us. Nevro Professional Education Team LEARN MORE www.Nevro.com 1800 Bridge Parkway Redwood City, CA 94065 © 2020 Nevro Corp. All rights reserved.

Nevro · 1800 Bridge Pkwy · Redwood City, CA 94065-1164 · USA ​

 

[trunksvegeta]

Doxy can collect payments through a separate company called stripes but doesn’t really integrate into an emr. You can share screen though if you want to show some imaging or other information to the patient.

So doxy doesnt have an option within its own platform to document patient encounters like and emr i.e. info/follow ups, patient demo, insurance info etc?
thx

 

[BobBarker]

So doxy doesnt have an option within its own platform to document patient encounters like and emr i.e. info/follow ups, patient demo, insurance info etc?
thx

Correct, and they don’t appear to be working on it either.

 

[DOctorJay]

Found this on Twitter


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[drusso]

 

[TIVAndy]

View attachment 300380

i would prob like to substitute one box with : patient naked on screen. had two of those already. they were taking call in bed.

 

[Ducttape]

speaking of A5... how many of you have thought about buying the Flobee?

 

[Multimodal]

View attachment 300051

Found this on Twitter


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As far as I know, we can't see new patients over telemedicine even if they have audio and video. I thought that we had to have an established relationship with the patient to do this. Also, at least in washington state, they made payment parity between in office - telehealth w/ video - and audio only telehealth(ie telephone visit) so it all gets paid as an in office visit. They don't recommend us using the Gxxx or 994xx codes at this time. I would check with your state DOH regarding local differences in this billing schema.

 

[DoYouEvenLiftBro]

what are you guys doing for physical exam?

 

[DOctorJay]

what are you guys doing for physical exam?

I'm documenting whatever I can visualize/observe. I'm trying to have the patient do certain maneuvers like range of motion or standing on heels and toes, as well as pointing to an area of pain or pressing on areas to determine point tenderness.

 

[Ligament]

You all know these ****ing insurance companies are going to retroactively deny, reduce or audit payment on telemedicine because you did not document enough checkpoints, and they are going to wait until this COVID issue is all over and there is nothing we can do to fix it. They are going to clawback a huge % of what we bill.

 

[Ferrismonk]

For what it's worth, I was recently told that Medicare will pay for 99213/etc via telehealth, but they're going to pay at professional fee rate (i.e. as if you were in the hospital) because the normal office payment rate includes overhead/supplies/staff which they think isn't necessary for a telehealth visit.

 

[geauxg8rs]

For what it's worth, I was recently told that Medicare will pay for 99213/etc via telehealth, but they're going to pay at professional fee rate (i.e. as if you were in the hospital) because the normal office payment rate includes overhead/supplies/staff which they think isn't necessary for a telehealth visit.

So i can get rid of my overhead during this time? Sweet, I’ll tell the landlord

 

[knoxdoc]

I've been doing follow ups via Doxy.me and it has been ok. About a third of patients are somewhat tech savvy (they can point a camera at themselves). Another third can give me the equivalent of a bigfoot sighting. The final third is like talking to Charlie Brown's mom or I get a good look at their ceiling. For these reasons, I have not tried to do any new consults yet. I just know the physical exam would be worthless. Lets face it, in this specialty it can be hard enough to cinch a diagnosis. Not being able to palpate, check strength, and check reflexes, etc is a huge loss if you ask me. The last thing I want to do is miss a myelopathy because I can't check reflexes. OTOH, bringing patients into the office is only going to put my staff and me at risk. This sucks. Any great advice? Success stories? Anyone wanna be my Corona monkey and go house to house reporting physical exam findings?

 

[geauxg8rs]

I've been doing follow ups via Doxy.me and it has been ok. About a third of patients are somewhat tech savvy (they can point a camera at themselves). Another third can give me the equivalent of a bigfoot sighting. The final third is like talking to Charlie Brown's mom or I get a good look at their ceiling. For these reasons, I have not tried to do any new consults yet. I just know the physical exam would be worthless. Lets face it, in this specialty it can be hard enough to cinch a diagnosis. Not being able to palpate, check strength, and check reflexes, etc is a huge loss if you ask me. The last thing I want to do is miss a myelopathy because I can't check reflexes. OTOH, bringing patients into the office is only going to put my staff and me at risk. This sucks. Any great advice? Success stories? Anyone wanna be my Corona monkey and go house to house reporting physical exam findings?

I am surprised daily at how different things can be on paper, or told verbally to me, vs reality. I get at least once a week a difference of left and right. Patient will either draw or say right leg when they show me left leg during exam. They say or draw “back” and i am looking at their waist when they are hurting between shoulder blades.

My favorite is that the patient thinks I am the *****. “Doc, no it’s my other leg that hurts.”
I just have to keep my thoughts to myself and die a little on the inside.

 

[cowboydoc]

Potentially great news...I saw doximity had a teaser for adding a videochat feature to their calling system. Like facetime, but you can have a dummy phone number.

 

[painfree23]

Potentially great news...I saw doximity had a teaser for adding a videochat feature to their calling system. Like facetime, but you can have a dummy phone number.

Yea It’s up and running

 

[DOctorJay]

I’m apparently on a waitlist


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[cowboydoc]

I’m apparently on a waitlist


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#metoo

 

[jonnylingo]

I find the Epic -> Cantu/Haiku workflow works about 1/3 for Video visits.
When that fails, I try doxy.me. This works about half of the time on those patients.
For the remaining 1/3 patient encounters, I resort to telemedicine. This is the equivalent of bringing a patient into clinic and speaking with them through a shut door.

So it's hit and miss.

Question -- for patients requesting tele over video visit, do you acquiesce or insist on video?
With stark difference in regards to the quality of encounter and reimbursement, I've almost given up on telephone encounters.

 

[hyperalgesia]

I'm starting to get nurses and other hospital employees asking to be on my "healthcare team". There's gonna be a lot more spoofing going on lol.

 

[Jcm800]

I find the Epic -> Cantu/Haiku workflow works about 1/3 for Video visits.
When that fails, I try doxy.me. This works about half of the time on those patients.
For the remaining 1/3 patient encounters, I resort to telemedicine. This is the equivalent of bringing a patient into clinic and speaking with them through a shut door.

So it's hit and miss.

Question -- for patients requesting tele over video visit, do you acquiesce or insist on video?
With stark difference in regards to the quality of encounter and reimbursement, I've almost given up on telephone encounters.

Interesting point. Telephone visits are a waste of time. But how do INSIST it be video. I just tell them we can do telephone this month, because next month we will be out of business...

 

[Jcm800]

Do those using Doximity prefer that to doxy.me?

 

[iwumd07]

When can we start doing procedures again?

I have other doctors and surgeons offices calling me complaining that we didn't do the 'recommended procedure' yet. When we tell them that no one is doing them right now, they're telling me that several other pain docs in the area are still doing them (but they can't mention whom).

 

[DOctorJay]

Do those using Doximity prefer that to doxy.me?

They’re very similar but you must use smartphones with Doximity.

Doxy.me allows for computer or iPad use as well as smartphones.

I’ve been switching back and forth and trying to be flexible and meet my patients where they are with tech.

FaceTime and Google Duo (you can use duo from your computer on chrome browser) are definitely getting some use as well.


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[Jcm800]

When can we start doing procedures again?

I have other doctors and surgeons offices calling me complaining that we didn't do the 'recommended procedure' yet. When we tell them that no one is doing them right now, they're telling me that several other pain docs in the area are still doing them (but they can't mention whom).

I am experiencing a similar situation

 

[Nonphysiologic]

Ok so it seems like if it’s Audio only it’s a G code. I was under the impression that during thing COVID crisis only we could have Audio only and bill as a regular visit as well. Guess not. Thanks for clarifying. I’m going to try and convince all my patients to do audio and video then.


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[SSdoc33]

Ok so it seems like if it’s Audio only it’s a G code. I was under the impression that during thing COVID crisis only we could have Audio only and bill as a regular visit as well. Guess not. Thanks for clarifying. I’m going to try and convince all my patients to do audio and video then.


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Again, thats not what im being told. Im only doing telephone and billing 9921x

 

[Sig123]

Again, thats not what im being told. Im only doing telephone and billing 9921x

Same in my practice.

 

[lonelobo]

State and insurance dependent....telephone satisfies in my state