May 2020


Covid-19 News You Can Use
Implementing tele-ophthalmology programs: webinar recap

by Ellen Stodola Editorial Co-Director

An overview of options for types of telemedicine services during the COVID-19 public health emergency with codes and reimbursement noted
Source: Ranya Habash, MD

At the end of March, ASCRS hosted the webinar “Implementing Tele-Ophthalmology During COVID-19 Pandemic,” providing information on options for telehealth moving forward and codes ophthalmologists can use to reimburse these services during the pandemic. An updated version of the webinar was hosted by ASOA in early April. The webinar was presented by Ranya Habash, MD, a member of the ASCRS/ASOA Telemedicine Task Force. It was sponsored by Novartis.
During her presentation, Dr. Habash mentioned the Centers for Medicare & Medicaid Services’ (CMS) expansion of Medicare telehealth benefits during the COVID-19 outbreak. This includes removing originating site requirements (effective March 1, 2020 and for the duration of the COVID-19 public health emergency, Medicare will make payment for professional services furnished to beneficiaries nationwide in all settings, including their homes), waiving HIPAA requirements (during the COVID-19 nationwide public health emergency, the U.S. Department of Health and Human Services [HHS] is removing penalties for HIPAA violations against providers; communication technologies such as FaceTime or Skype may be used), and lifting restrictions on established vs. new patients (according to CMS, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during the public health emergency; new patients are now eligible for phone calls, e-visits, and virtual check-ins).
In terms of Medicare payments, Medicare will make payments for telehealth services furnished to patients in broader circumstances. These visits are considered the same as in-person visits and are paid at the same rate as in-person visits. There is also flexibility in waiving deductibles and copays, and prior authorization requirements have been suspended. Non-Medicare payors are encouraged to follow the same CMS guidelines for coverage during this time, and most private payors are offering $0 copays for telemedicine visits. Additionally, the narrow scope of certain diagnostic codes is dropped, and practicing across state lines is now authorized by Medicare. Physicians licensed in one state can provide services to Medicare beneficiaries in another state (state licensure laws still apply).
Dr. Habash also highlighted some best practices for implementing telemedicine programs:
• Engage office staff for administration of telehealth and continuity of care
• Establish phone call routing, emergency calls, and route requests for telemedicine
• Be proactive; go through existing schedules to identify patients for telehealth
• Create telemedicine consent forms (she said there are many resources online for this)
• Use video platforms, like Zoom, Skype, FaceTime, Doximity, and Microsoft Teams
• Engage patients with apps
• Use templates for telemedicine encounters
• Send email announcements to patients such as: “Great news! Your doctor is now offering telemedicine visits to keep you cared for during this crisis …” (patients appreciate this rather than a message saying the office is closed during this time)
Dr. Habash discussed coding for telemedicine visits, as this has changed as well. She discussed video visits, phone calls, virtual check-ins, reviewing photos, e-visits, and doctor to doctor consults for both the consulting doctor and the referring doctor. The included chart provides a summary of these services, which codes to use, and reimbursement for each.
For practices using remote monitoring, there are code options for setup (99453, $18.77), the device (99454, $62.44/month), and monitoring (99457, $51.61/month). This covers setup and patient education on the equipment as well as the monitoring device. To qualify, there must be more the 20 minutes of monitoring per month, including communication with the patient.
Dr. Habash spoke about the options for “hybrid tele-visits.” These might be used when a patient has a medical necessity to come to the office for a specific test or expedited workup, then the physician reviews the testing and corresponds with the patient about results via call or video chat. For these, practices would bill an E/M code just like an office visit, Dr. Habash said. This option may help in several ways, she said, by keeping emergent patients cared for while reducing exposure potential among patients, staff, and physicians.

About the doctor

Ranya Habash, MD
Medical director of technology innovation
Assistant professor of clinical ophthalmology
Bascom Palmer Eye Institute
Miami, Florida

Relevant disclosures

: None

COVID-19 update (as of April 28, 2020)

•981,246 U.S. cases, according to CDC
•55,258 U.S. deaths, according to CDC
•2,954,222 cases worldwide, according to WHO
•202,597 deaths worldwide, according to WHO
Treatment: No proven curative treat­ment; various treatments in clinical trials
Vaccine: Vaccine trials have begun in the U.S.

Implementing tele-ophthalmology programs: webinar recap Implementing tele-ophthalmology programs: webinar recap
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