Welcome to this week’s healthcare Knowledge Knugget! As a part of “The Executive Innovation Show” podcast, we’re bringing you the hot topics, questions we receive each week and game-changing ideas, best practices and tips. Today’s topic comes from Carol Ermis.
Today, Carol is going to address three key topics. First, what are some good use cases for telehealth in orthopedics for new patient consults? She will also speak about rural access, driving distances, medical transport and how telehealth also makes sense for folks driving out of state for consults.
The second topic/question she answers is, do telehealth consults require a physical exam? Hear what she has to say on post-surgery consults, wound care and some great things about reviewing films.
Lastly, it’s a question we get all the time, what are common billable codes for ortho and what you should be doing with GT modifiers.
Carol Ermis is the Revenue Cycle Director for Orthopaedic Specialist of Austin in Austin, Texas. She has worked in the field of medical billing and coding for 20 years with the last 14 years being dedicated to the revenue cycle of orthopedic surgery.
What are the patient types that make the most sense to use telehealth for consultations in orthopedics?
It makes sense to use telehealth for patients who live far away from the office and patients who live in rural areas where there's often a shortage of specialists. It may also make sense for patients who live out of the state or for patients who don't have transportation available to them to come to the office. It also is sometimes appropriate to use telehealth for patients who have been admitted to a medical facility.
Patients who are in a nursing home or who have been admitted to the hospital and can't medically be safely or easily transported to the office.
What appointment types in orthopedics do not require a physical exam and can they be converted to telehealth to free up waiting rooms?
There are a couple of kinds of appointments that don't require a physical exam from an orthopedic surgeon that could be used for telehealth. Surgical follow-ups, wound checks that don't require a suture removal or staple removal can be done via telehealth.
Also, appointments that are basically the doctor delivering diagnostic information to the patient. So if the patient has had an MRI or a CT scan done and the doctor has reviewed the films and is delivering information to the patient about their diagnosis, about their treatment options and answering the patient's questions.
There are some patients who are ready to return to work or to sports really quickly after an injury or surgery and they don't want to take the time to travel to the doctor's office for a quick recheck. So adding telehealth, adding a video to a regular phone call means that the surgeon can feel satisfied that the patient has healed properly while still meeting the needs of the patient.
What are the most common billable codes in orthopedics with the GT modifier for telehealth?
Right now, most commercial payers will cover telemedicine visit services and they're advising healthcare providers to bill an evaluation and management code for telemedicine appointments. That's 99201 - 99205 which is your standard outpatient office visit codes for new or established patients.
They're also going to be looking for a GT modifier to be appended to those codes to let them know that the visit took place virtually via telehealth rather than in person. Whatever kind of telemedicine service you're providing or whatever insurance you're working with, always call beforehand and confirm what their telehealth billing guidelines are.
Ask which specific billing codes you should use and whether they recognize the GT modifier. If they have a published policy about their coverage of telemedicine, review it before you call and be armed with that information about their coverage policies when you contact them.
That has been today's Knowledge Knugget with Carol Ermis. If you have any additional questions, you can find her on LinkedIn.
That's today's healthcare Knowledge Knugget, part of The Executive Innovation Show. Feel free to submit questions or be featured on the Knowledge Knugget. Subscribe to our YouTube, Vimeo, and the podcast channels to get your Knowledge Knugget on Thursdays.
Download our playbook where we define "What is Telehealth?". We go over top implementation areas for telehealth such as post and pre-surgery consults in orthopedics. We also layout the top benefits of telehealth and even more use cases.