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A comprehensive overview of telehealth, exploring its history, applications, and ethical considerations. It delves into the various types of telehealth services, including synchronous and asynchronous visits, home-based monitoring, and technology-based eye care. The document also covers essential aspects like cpt codes, icd-10 codes, licensing requirements, hipaa compliance, data security, and malpractice insurance. It concludes with a discussion on the ethics of telehealth and the role of artificial intelligence in the field.
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What are the barriers to care? Access to Quality Care Transportation Resources Perceived Need What is the roll of telehealth? Another "tool in the toolbox" Helps eliminate some barriers to care Works well when utilized alongside in-person care to prevent vision loss Telemedicine designed to integrate telecommunications into diagnostic and therapeutic intervention. Telehealth designed to integrate telecommunication systems into the practice of protecting and promoting health. Synchronous either a clinic or home-based telehealth visit where the patient and provider meet in real-time via video conference, live chat, or telephone.
Asynchronous (aka SFT): health information is acquired, transmitted to a secure location, and reviewed by a distant provider at a different time. Clinic based telehealth a synchronous or asynchronous visit in a clinical setting with a clinical staff member supporting the visit Home-based monitoring telehealth: the patient collects and/or submits information to a provider from home or a non-clinic setting. Who was the first person that transmitted the first tele-electrocardiogram? Willem Einthoven 1905 What happened in 1959 with telehealth? University of Nebraska uses a two-way television communication system to share information with medical students; this leads to video consults with local hospitals. What happened in the 1970-1980s for telehealth? NASA, STARPAHC what happened in 2020 with telehealth?
IOP measurement: iCare, Tonopen Pachymetry: handheld pachymeter Anterior Segment Imaging: Slit-lamp camera provides better quality compared to a slit-lamp adapter Posterior Segment Imaging: Canon, Eidon, Optos, Clarus, Topcon, Marco Perimetry: Humphrey vs others Optical Coherence Tomography (OCT): solo or in combination with a fundus camera (Topcon Maestro and Zeiss Cirrus) CPT Codes for Synchronous Telehealth (with modifier 95) 99201: 10 minutes, straightforward 99202: 20 minutes, straightforward
99203: 30 minutes, low decision making 99204: 45 minutes, moderate decision making 99205: 60 minutes, high decision making CPT Codes for Asynchronous Telehealth Provider 99091: collection and interpretation of physiological data requiring a minimum of 30 minutes of cumulative time spent by the telehealth facilitator and the provider 99451: greater than or equal to 5 minutes but less than 30 minutes spent in EMR CPT Codes for Asynchronous Telehealth Facilitator "Z" code is not required to match the provider code Testing and exam portion on the patient side are billed e.g. autorefraction OR refraction, glasses fitting, ancillary testing ICD-10 Codes for Asynchronous Telehealth Z01.00: encounter for examination of eyes and vision without abnormal findings Z01.01: encounter for examination of eyes and vision with abnormal findings
negligence due to a breach of duty within the provider-patient relationship Malpractice Insurance: Does the carrier provide coverage for telehealth services? Online Prescribing: different considerations for medications and glasses What are the ethics of telehealth? Quality of Care Safety Patient Education Artificial Intelligence: new 92229 code (retinal imaging with automated point of care) Includes codes 92250 (fundus photo), 92185 (external photo), and 92134 (OCT macula)