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Telehealth: Another Tool for Your Toolbox

By Amber Belaustegui, OD June 03, 2020

To be honest, I was pretty skeptical about telehealth pre-COVID-19. I could see handling some aspects of patient care remotely, but couldn’t envision treating patients without physically seeing them, putting dye in their eyes, and examining their eyes up-close and magnified. I have learned during this pandemic, however, that there are a lot of situations that can be managed successfully with telehealth.  

My practice is based in Fallon, Nevada, a rural town about an hour from Reno. Many of my patients live far away and can’t always make the trek to my office. So, for years, I have provided limited telemedicine to supplement patients' in-office care. One patient, a rancher who lives over an hour away, gets recurrent idiopathic iritis every one-to-two years and getting him to come in for multiple visits each time isn’t realistic. The last time he started experiencing symptoms, he was in the middle of moving a herd and couldn’t get to me for a few days. So, I spoke to him on the phone and documented the symptoms he disclosed. After I checked his history, made sure he wasn’t a steroid responder, and checked the previous treatment regimen, I sent in a prescription so he could start treatment right away and then come in for a recheck and a follow up check after the final taper. 

Since I prescribed a treatment and discussed the symptoms in real time with the patient, I was able to bill 99213 (with the correct modifier) to let the insurance company know this visit did not take place in the office. And, I was able to follow his treatment to completion while requiring one less trip and a better overall experience for him.  

My use of telemedicine kicked into high gear during COVID-19, as we were required to shelter-in-place. One woman I treated was a glaucoma patient I have been seeing for 10 years. She has always been very involved in her care, and I educate her as much as possible each time she comes in. During suspension of routine eye care, this patient frantically called my office, reporting that her drops were no longer working, and she was bleeding in her eye. She wanted to drive to my office and have her pressure checked.  

I called the patient and we discussed her drop regimen, since I had recently instructed her to increase dosage frequency. Per usual, she had been compliant with my instruction. As she described the “bleeding in her eye,” it was clear that she had a subconjunctival hemorrhage—a diagnosis that was confirmed when she sent me a picture of her eye. Upon questioning, I learned she had spent the last two days doing strenuous yard work, bending and lifting heavy items, and her eye allergies were “off the chart.” After explaining that the “bleed” was likely caused by her allergies and recent activities, I called in a prescription for a mast cell stabilizer to help alleviate the ocular allergies, educated her on the prognosis and timeline of healing of the hemorrhage, and noted in her chart to schedule a pressure check once routine care resumed. Although I was able to bill 99213 (again with the correct modifier), the real benefit I received from this interaction was the abundant gratitude the patient expressed. She said no other doctor had ever called her personally, and that while she had always valued our relationship, this day’s interaction brought her to tears of relief. She thanked me over and over. 

It is always rewarding when we can use the tools at our disposal to help our patients during a time of need. As I see it, telehealth will never replace what we are able to do in-person in our practices, but it is one more tool we can add to our toolboxes. During these challenging days, as I seek to treat my patients safely and effectively, I’ll take every tool I can get!      

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