Before you start: Patient needs to be scheduled under the correct visit type (one of the following options):
- NPV MANAGEMENT DURING COVID-19 [3599]
- RPV MANAGEMENT DURING COVID-19 [3592]
- TELEHEALTH NON-BILLABLE [3621]
- TELEHEALTH GROUP SESSION [3654]
- TELEHEALTH GROUP NON-BILLABLE [3655]
In order for the encounter to be fully completed, practice staff need to "arrive" the patient. This is optimally done before starting the visit with the patient but can be done within 72 hours of the encounter time during the COVID-19 emergency only. Please check with your practice leadership on how your practice will "arrive" a patient.
Based on practice workflows: Patient can be contacted by practice staff (RN, MA, APP) for chart updates, medication reconciliation, review of systems, etc. following the usual protocol for an office visit.
Documentation for providers: Can be done using your normal template OR new telemedicine phone (.COVTELEPHONE) or video-specific templates (.COVVIDEO).
The following exam elements can be included:
Vital signs reported from the patient (make sure to note that vital signs are patient-reported): Heart rate, blood pressure, weight
Telephone visit
Gen: No acute distress, not audibly anxious, speaking comfortably
Neuro: Alert and oriented x3, interactive
Psych: Pleasant, normal affect
Video visit
Gen: No acute distress, not anxious-appearing, speaking comfortably
HEENT: Bulbar conjunctiva clear, lips not swollen, no visible neck masses
Resp: Good inspiratory effort, no use of accessory muscles, no increased work of breathing
Skin: No rash on visible, exposed areas
Neuro: Alert and oriented x3, interactive
Psych: Pleasant, normal affect
You can state that you reviewed images, lab tests, etc. as well as other patient-reported data like Apple Watch or Kardia ECG tracings.
For video or audio-only visits, clinicians can choose to bill/select the appropriate E/M code by medical decision making OR time-based guidelines (whichever is more favorable), using the AMA 2021 E/M Guidelines. If using your own note template, include documentation for telemedicine visit modality: .COVTELEDOC will include the time-based SmartPhrase for a telephone or video visit to be added to the bottom of the note.
Note: For clinicians conducting audio-only visits, it is important to use .COVTELEDOC to document time regardless of billing by medical decision making or time in case a backend billing process needs to convert to audio-only billing codes depending on payer requirements.
Orders
Medications can be e-prescribed. Lab orders will need to be sent to patients. Order testing can be ordered then included on AVS for staff to schedule.
Patient instructions
Should be included as usual on AVS and will be visible to patients via myPennMedicine. There are a number of patient education SmartPhrases, all of which start with .COVID.
Follow-up
Include follow-up as usual on AVS. Staff will need to review schedule daily to contact patients to arrange next follow-up visit and schedule any testing/procedures. If patient has a reason to be seen in person, or requires in-person testing, a face-to-face visit should be scheduled per provider.