TELEMEDICINE

Updated April 22, 2020

MAJ Roach, Walter Reed Nat’l Mil Med Ctr

TELEMEDICINE: MODALITIES

SPEC-HC, Telephone Consultation

Asynchronous and Synchronous

SPEC-HC, TELEPHONE CONSULTATION

TELEMEDICINE: SPEC-HC, TELEPHONE CONSULTATION

Telephone Consultation Coding Criteria (i.e. Virtual Encounter, SPEC-HC):

A telephone consultation will be considered codeable if the following criteria is

met:

Patient must be an established patient

Encounter may not be originating from a related assessment and

management service provided within previous 7 days.

Encounter may not lead to a face-to-face assessment and management

service or procedure within 24 hours or soonest available appointment.

Documentation must show the provider gave substantive medical advice

or medical decision making

TELEMEDICINE: SPEC-HC, TELEPHONE CONSULTATIONNon-Codeable telephone consult (i.e. T-con):

• Nurse Advice Line

• New patient interaction

• Communication of non-clinical information

• Providing test results without any medical decision making

• Leaving messages on answering machines

• Telephone services referring to an E&M service performed and reported by the same provider occurring within the past 7 day

• Telephone services ending with a decision to see the patient within 24 hours or next available urgent visit appointment

• Telephone services occurring within the post-operative period of the previous completed procedure

• Telephone services completed by residents that are PGY-l's

• Scheduling/Billing/ Administrative issues

TELEMEDICINE: SPEC-HC, TELEPHONE CONSULTATION

Telephone Consultation CHCS Template

TELEMEDICINE: SPEC-HC, TELEPHONE CONSULTATION

Virtual Encounter, SPEC-HC: Examples

Establish common patient complaints for your clinic for nurses and administrative staff to consider deferring a face-face encounter for a virtual SPEC-HC visit. Providers scrub the list and convert a FTR/24HR to VIRTUAL

Examples for Adolescent Medicine visits: Behavioral health follow-ups, acne, URI/AGE, seasonal allergies, headaches, lab result review and medication adjustments

TELEMEDICINE: SPEC-HC, TELEPHONE CONSULTATION

Telephone Consultation Coding (i.e. Virtual Encounter, SPEC-HC):

A scheduled provider to established patient telephone call, documented within the appointment module that meets TCON coding criteria will be coded as:

-ICD-10-CM -diagnosis/signs and symptoms

-E&M-99499 -Other/unlisted E&M

-CPT/HCPCS-T2025 Waiver Services; Not Otherwise Specified (NOS)

(please note the change from G2012 following recent DHA coding guidance update)

Documentation must state that the visit is being performed using telephone communication, and clearly define amount of time spent in conversation with patient.

ASYNCHRONOUS &

SYNCHRONOUS AUDIO/VISUAL FACE TO FACE ENCOUNTERS

TELEMEDICINE: ASYNCHRONOUS & SYNCHRONOUS

Asynchronous

Asynchronous VH – ‘store and forward’ telehealth. In this case, an encounter is based on evaluation of relevant patient information and/or digital images, such as X-Rays, dermatology images and others which are captured locally, then temporarily stored (cached). The provider then reviews the stored data and makes diagnosis, treatment, and/or planning recommendations.

Synchronous

Synchronous VH – real-time telehealth. Synchronous VH sessions are live, interactive, and use videoconferencing technologies, i.e. Adobe Connect.

TELEMEDICINE: ASYNCHRONOUS

Consulted provider is reviewing stored documentation to

provide interpretation or opinion to requesting provider.

Example: Cardiology

Holtor monitor interpretation from a cardiologist at WRNMMC is

sent to a PCM at Fairfax Health Center

TELEMEDICINE: SYNCHRONOUS AUDIO/VISUAL FACE

TO FACE ENCOUNTERS- ADOBE CONNECT

TELEMEDICINE: SYNCHRONOUS AUDIO/VISUAL FACE

TO FACE ENCOUNTERS- ADOBE CONNECT

Provider Training Requirement:

Virtual Health training in JKO. Prefix: DHA, Course Number-US444

DHA Virtual Health Provider Training (45 min)

https://jkodirect.jten.mil/

TELEMEDICINE: SYNCHRONOUS AUDIO/VISUAL FACE TO

FACE ENCOUNTERS- ADOBE CONNECT

Provider Training Requirement:

Email the certificate to the

1) VH Provider Training Credential Coordinator

2) WRNMMC Credentialing Office:

dha.bethesda.j-11.mbx.ncrthd@mail.mil

allen.c.kumru.civ@mail.mil

Peds please save a copy in the Shares<Pediatrics<TELEMEDICINE<Training Certificates

ADOBE CONNECT USERNAME/PASSWORD

TELEMEDICINE: SYNCHRONOUS AUDIO/VISUAL FACE TO

FACE ENCOUNTERS- ADOBE CONNECT

Establish Adobe Connect Account Sign-In

See Adobe Connect how-to guide and patient

information guide

Disable audio and utilize a land line for audio due to

delay in Adobe Connect

HTTPS://FBCH.ACMS.COM

TELEMEDICINE: PROVIDER, MEETING SET-UP

TELEMEDICINE: PROVIDER URL

TELEMEDICINE: ENTER THE MEETING ROOM

Download the Adobe Connect App

Copy the provider’s URL, hit next

Join as a guest with identifying name, hit enter

ADOBE CONNECT: PATIENT

TELEMEDICINE: SYNCHRONOUS AUDIO/VISUAL FACE TO

FACE ENCOUNTERS- ADOBE CONNECT

TELEMEDICINE: VERBIAGE EXAMPLESConsent

"The patient has been informed about the benefits and limitations of care delivered via virtual health. The

patient understands he/she reserves the right to in-person care and refusal of virtual healthcare but elects

virtual healthcare today. Verbal consent received to proceed with the visit via the virtual health

platform.’’

Patient Identifiers

Patient identity confirmed prior to the Virtual Health Appointment with full name and DOB verified.

<INSERT patient name> is currently located at 1234 Virtual Health Way, Bethesda, MD 20889. Patient

phone: (301) 555-5555. Local contact: <INSERT name> at (301) 555-5556.

Emergency Action Plan

The patient understands to seek immediate attention if a medical or mental health emergency arises to

include suicidal or homicidal thoughts, and agrees to do so. The patient should report these concerns to

any of his/her providers if available, go to the nearest Emergency Room, or call 911. National Hopeline

Network at 1-800-SUICIDE and National Suicide Prevention Line 1-800-273-TALK also discussed for mental

health emergencies. Prior to initiating a virtual patient encounter, the provider will ask for the patient’s

physical location/address and a good emergency contact phone number. In the event of an

emergency, the provider will use this address to call 911 and direct emergency services to the patient’s

physical location. The provider will stay connected with the patient until emergency services arrive if

possible.

ADOBE CONNECT, SYNCHRONOUS

MODIFIER: 95 – SYNCH TELEMEDICINE

ADMINISTRATIVE BOOKING

Standardize “Reason for Appointment” to ease face-face vs. virtual visit planning

TELMED VTC (insert reason)

TELMED Phone (insert reason)

TELEMEDICINE: TELEWORK AGREEMENT

Supervisor granted agreement to allow a provider to

telework from home. Establish employee

expectations, productivity and work hours.

Ensure equipment is functioning and network

connection supports needed telework capabilities.

DD FORM 2946

QUESTIONS?National Capital Region Virtual Health Program

Wendy Baynard (301) 319-3774, Wendy.F.Baynard.ctr@mail.mil

Adolescent and Young Adult Medicine, Pediatrics

Lindsay Roach (210) 332-0627, Lindsay.E.Roach.mil@mail.mil