Orthopedists were walloped by COVID, with drops in office visits and elective procedures. Although telehealth was used initially as an emergency measure, many ortho organizations have realized the value of virtual visits and see them as a tool to improve patient outcomes and satisfaction. The post-pandemic challenge is finding the optimal balance between virtual and in-person visits to achieve the best health outcomes while retaining telehealth resources should pandemic lock-down measures be necessary for the future.

Finding your balance

“In some ways, post-pandemic operations will look different than the pre-pandemic normal,” said Mary Sue Winland, Director, athenaOne Division of Virtual OfficeWare Healthcare Solutions (VOWHS). “We’ve noticed many ortho practices are combining feedback from staff with claims analytics to find the telehealth opportunities that maximize provider time, create positive patient outcomes, and expand revenue streams.”
Winland recommends concentrating telehealth efforts in three categories: improving post-op outcomes, developing the capabilities to perform online evaluations, and virtual triage.

Improving patient post-op outcomes

Since most provider encounters after procedures are covered under global billing guidelines, one of the most significant assets of virtual visits is the opportunity for post-operative check-ins. Many post-ops need to be in-person. However, there are occasions when patients have questions, want to voice concerns, or a simple wound check needs to be performed. Virtual visits embedded into post-op workflows can help providers streamline visit scheduling, potentially opening time slots for new cases. Virtual follow-up visits can also be aligned with value-based care models to help ensure positive measure outcomes, a win-win for patients and providers.

According to Winland, “After global periods have passed, orthopedists should not overlook telemedicine CPTs for E-Visits such as 99421-99423, which is essentially provider email responses to established patients about health issues.” Documenting and billing seemingly small interactions have the potential to add revenue.

Transitioning to virtual visits for orthopedic exams

Although still in its infancy, protocols and methods to diagnose common musculoskeletal conditions are developing. A recent article in The Journal of Bone and Joint Surgery outlines the essential elements of a telehealth orthopedic examination. These virtual visits combine prior radiographic imaging and virtual face-to-face assessment for evaluation.

One potential advantage of telemedicine evaluations is the use of web tools to measure symmetry, alignment, angles, obliquity, and length. During the virtual visit, patients can demonstrate tests such as flexion, adduction, and internal rotation (FADIR) and flexion, abduction, and external rotation (FABER). Providers can perform strength tests with everyday household items such as a stapler, bottle of water, or half-gallon of milk. Patients need to be prepared for a virtual visit with the correct clothing and objects and understand how to use technology, excluding some populations. However, telemedicine can be a reliable alternative to in-person visits when patients are prevented from reaching an office.

Pre-visit triage to determine appropriate next steps

Virtual triage may be especially valuable for patients that reside in areas battling COVID outbreaks and are reluctant to go to an ER. “Two underutilized triage telemedicine codes useful to orthopedics are G2010 for remote evaluation of images and G2012 for a brief communication via technology,” said Winland. “Creating triage workflows that accommodate technology has the potential to quickly provide critical information to determine the best course of action for a patient.”
Integrating telemedicine into your practice

Although unexpected, the changes necessitated by COVID have brought the advantages of virtual care to the forefront. When opportunities for telemedicine are integrated into everyday workflows, patients that may not have had access to timely treatment have a viable alternative to waiting or traveling long distances for care. Another potential benefit to patients is the opportunity for providers to collaborate and coordinate care. Reimbursement already exists for interprofessional health record consultations (CPTs 99446-99449). It is not difficult to imagine future scenarios where orthopedists use telemedicine to work with other disciplines, such as pediatricians and therapists, to consult on cases while the patient is still in the office. As telemedicine capabilities develop, so too will innovative ways for orthopedic providers to use, and bill for, the technology.

Staying at the forefront of telemedicine reimbursement can be challenging – using the right partner for practice management software and billing makes it easy. Contact us today at (412) 424-2260 or visit vowhs.com to learn how we can help you optimize workflows, streamline claims, and maximize revenue.