Cohen Bruce H, Busis Neil A, Ciccarelli Luana
Continuum (Minneap Minn). 2020 Jun;26(3):785-798. doi: 10.1212/CON.0000000000000874.
Almost all medical care in the United States is delivered with the provider and patient in immediate proximity; this model is referred to as face-to-face care. Medical services can be apportioned as procedural care (eg, surgery, radiology, or laboratory testing and others) or cognitive care, also known as Evaluation and Management (E/M) services, in which the provider formulates an assessment and plan after obtaining information from the patient's history, examination, and diagnostic tests.Providing a medical opinion and plan using the telephone as the technology that links the provider and the patient is an example of a non-face-to-face E/M service. Common Procedural Terminology (CPT) codes and the details for how to provide telephone services have been available for decades but have not been reimbursed and therefore were rarely used. In recent years, as new technologies have evolved, there has been slow and steady acceptance that non-face-to-face E/M care can be an adjunct to or replacement for some face-to-face E/M services. These technologies and the descriptors for associated CPT and Healthcare Common Procedure Coding System (HCPCS) codes were introduced over the past few years and have become known by the generic term telehealth. They have been slowly incorporated into medical practice. Most of these services were introduced in the consumer retail market, in which the cost was borne directly by the patient, or as private contract services, in which the cost was borne by the consulting hospital, such as with telestroke services. In both the consumer retail model and private contract model, the care delivered usually did not involve CPT or HCPCS coding. The adoption of telehealth has been slow, in part because of the initial costs and several regulatory constraints, as well as the reluctance of patients, providers, and the insurance industry to change the concept that medical care could only be delivered when the patient and their provider were in physical proximity.After the COVID-19 pandemic reached the United States, the US Department of Health & Human Services issued a public health emergency and declared a Section 1135 Waiver that lifted many of the administrative constraints. With the need for near-absolute social distancing, this perfect storm has resulted in the immediate adoption of telemedicine, at least for the duration of the pandemic, for cognitive care to be delivered using communication technologies that are already in place. This article discusses the most common forms of non-face-to-face E/M care and the proper coding elements necessary to provide these services.
在美国，几乎所有医疗服务都是在医护人员和患者直接接触的情况下提供的；这种模式被称为面对面医疗。医疗服务可分为程序性医疗（如手术、放射学检查、实验室检测等）或认知性医疗，也称为评估与管理（E/M）服务，即医护人员在从患者病史、检查及诊断测试中获取信息后制定评估和治疗方案。利用电话作为连接医护人员和患者的技术来提供医疗意见和治疗方案，就是一种非面对面E/M服务的例子。通用程序术语（CPT）编码以及提供电话服务的详细说明已经存在数十年了，但此前一直未得到报销，因此很少被使用。近年来，随着新技术的发展，非面对面E/M护理可以作为某些面对面E/M服务的补充或替代方式，这一观点逐渐得到缓慢而稳定的认可。这些技术以及相关CPT和医疗保健通用程序编码系统（HCPCS）编码的描述在过去几年中被引入，并以通用术语“远程医疗”为人所知。它们已逐渐被纳入医疗实践。这些服务大多是在消费零售市场推出的，其费用由患者直接承担，或者作为私人合同服务，费用由咨询医院承担，比如远程中风服务。在消费零售模式和私人合同模式中，所提供的护理通常都不涉及CPT或HCPCS编码。远程医疗的采用一直很缓慢，部分原因在于初始成本、若干监管限制，以及患者、医护人员和保险业不愿改变只有患者及其医护人员在实际近距离接触时才能提供医疗服务的观念。在新冠疫情蔓延至美国后，美国卫生与公众服务部发布了公共卫生紧急状态声明，并宣布实施第1135条豁免条款，解除了许多行政限制。由于需要近乎绝对的社交距离，这场完美风暴导致远程医疗立即得到采用，至少在疫情期间，利用现有的通信技术来提供认知性医疗服务。本文讨论了非面对面E/M护理的最常见形式以及提供这些服务所需的正确编码要素。
