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Telehealth Well Visits: Practice Guidance

Version 20.3

Please read this complete article before accessing the Telehealth Well Visit Template Package here. 

Overview

Many insurance policies are now paying for child/adolescent Well Visits performed via Telehealth during the COVID-19 public health emergency. In order to facilitate incorporating preventive medicine services performed virtually, the standard Well Visit templates have been adapted for Telehealth use.

The adaptations are critical to appropriate documentation and to withstand an audit, but there are portions of the Well Visit that remain the responsibility of the practice. 

Before importing well visit templates...

Here are some key things to understand before importing well visit templates:

  1. Workflow items will have to be customized to what YOUR practice does at Well Visits.
  2. If you have different default ICDs associated with your templates, you may have to alter those imported on the template.
  3. If you have customized your Well Visits significantly from the default OP templates, you may decide to remake your own set based on your current Well Visit templates.
  4. If you have customized your ages/default minimum ages for your templates, you will have to adjust any imported templates.
  5. Be sure to remove/adapt any language that refers to care that is not possible to perform during a Telehealth visit. 
  6. Consider renaming the visits if you find the current nomenclature (TM-) difficult to find when applying templates or searching for them.
  7. Create an Appointment Type for these visits. Understand the “purpose” of the Appointment Type is linked to zones in your calendar. So, you should decide whether you want to schedule Telehealth Well Visits in your usual well zones, or have them separated into Telehealth zones. For example:

  1. Add the Visit Type this will be, according to your practice naming convention and consistent with the Appointment Types you created above.

  1. It is important to document the following information in the Visit Info window.
  • Who is accompanying the patient on the Telehealth visit.
  • Provider and Patient location in the Telehealth section. Once the Provider location and Patient location fields are completed, the Place of Service field updates to Telehealth.
  1. Users may find it useful to change their preference to open on Visit Info, by default. This will remind them to complete this information. This can be accomplished by right-clicking on Visit Info in the Window Navigation Panel.

Note: Setting the preference to open on the Visit Info will be applied to all Well Visit notes, and is not exclusive to Telehealth Well Visits.

What's Included in the Templates

  1. Wording emphasizing why this Well Visit is being performed via Telehealth:

Virtual Well Visit performed during COVID-19 public health emergency 

History reviewed and exam considered with limitations acknowledged due to the nature of virtual visit through a synchronous telecommunications system

  1. Since the current Well Visits do not have a place for documentation for the “endpoints” of the visit, the following has been included as text in the Interval History: Telehealth Provider Location: Office or Other*, Telehealth Patient Location: Home

*Providers will need to edit this field to document if they are doing this virtual visit from their office or from their home/other location
Aligning documentation for Sick and Well Visit templates with this information included in the visit details is being considered for a future release.

  1. Wording explaining that any vital signs recorded were not taken directly by an office team member has been included in the Plan section. 

Any vital signs/growth measurements reported were done so via patient/caregiver measurements and reported to provider, and interpreted as home measurements.

In addition, notation should be made in the Comment section of each vital sign:

  1. Wording regarding vaccines in the Plan was changed to include: 

which we will arrange to do when safe/appropriate in current environment to do so

  1. Additional wording regarding when face-to-face would be appropriate was added to the Plan:

Discussed under what circumstances a face-to-face office visit would be appropriate to address any identified problems.

  1. Wording has been added to document that the provider has:
  • Identified what components were missing from a comprehensive preventive medicine visit that was performed virtually
  • That those gaps were discussed with the patient/caregiver
  • That you have discussed how to close those gaps in the future

Identified gaps from performing comprehensive well visit in virtual environment, discussed with patient/caregiver including how to close those gaps when safe to do so in an in-person follow-up office visit.

  1. Items of the physical exam that cannot be performed virtually have been removed (for example: checking red reflexes, for hip range of motion, any auscultation or palpation language).
Version 20.2

Please read this complete article before accessing the Telehealth Well Visit Template Package here. 

Overview

Many insurance policies are now paying for child/adolescent Well Visits performed via Telehealth during the COVID-19 public health emergency. In order to facilitate incorporating preventive medicine services performed virtually, the standard Well Visit templates have been adapted for Telehealth use.

The adaptations are critical to appropriate documentation and to withstand an audit, but there are portions of the Well Visit that remain the responsibility of the practice. 

Before importing well visit templates...

Here are some key things to understand before importing well visit templates:

  1. Workflow items will have to be customized to what YOUR practice does at Well Visits.
  2. If you have different default ICDs associated with your templates, you may have to alter those imported on the template.
  3. If you have customized your Well Visits significantly from the default OP templates, you may decide to remake your own set based on your current Well Visit templates.
  4. If you have customized your ages/default minimum ages for your templates, you will have to adjust any imported templates.
  5. Be sure to remove/adapt any language that refers to care that is not possible to perform during a Telehealth visit. 
  6. Consider renaming the visits if you find the current nomenclature (TM-) difficult to find when applying templates or searching for them.
  7. Create an Appointment Type for these visits. Understand the “purpose” of the Appointment Type is linked to zones in your calendar. So, you should decide whether you want to schedule Telehealth Well Visits in your usual well zones, or have them separated into Telehealth zones. For example:

WarningIf your practice is recognized as PCMH or working toward recognition for PCMH, be sure to use the Originating and Distant Appointment Types so that the Telehealth visits are accurately calculated for AC06. 

  1. Add the Visit Type this will be, according to your practice naming convention and consistent with the Appointment Types you created above. 
  2. Since there is currently no place on the Well Visit templates to document Place of Service (consideration for future improvement), users will need to remember to document this information on the Visit Info.

  1. It is also important to document who the patient is accompanied by in the Accompanied by field of the Visit Information.
  2. Users may find it useful to change their preference to open on Visit Info, by default. This will remind them to complete this information. This can be accomplished by right-clicking on Visit Info in the Window Navigation Panel. Note, this preference will be applied to all Well Visit notes, and is not exclusive to Telehealth Well Visits.

What's Included in the Templates

  1. Wording emphasizing why this Well Visit is being performed via Telehealth:

Virtual Well Visit performed during COVID-19 public health emergency 

History reviewed and exam considered with limitations acknowledged due to the nature of virtual visit through a synchronous telecommunications system

  1. Since the current Well Visits do not have a place for documentation for the “endpoints” of the visit, the following has been included as text in the Interval History: Telehealth Provider Location: Office or Other*, Telehealth Patient Location: Home

*Providers will need to edit this field to document if they are doing this virtual visit from their office or from their home/other location
Aligning documentation for Sick and Well Visit templates with this information included in the visit details is being considered for a future release.

  1. Wording explaining that any vital signs recorded were not taken directly by an office team member has been included in the Plan section. 

Any vital signs/growth measurements reported were done so via patient/caregiver measurements and reported to provider, and interpreted as home measurements.

In addition, notation should be made in the Comment section of each vital sign:

  1. Wording regarding vaccines in the Plan was changed to include: 

which we will arrange to do when safe/appropriate in current environment to do so

  1. Additional wording regarding when face-to-face would be appropriate was added to the Plan:

Discussed under what circumstances a face-to-face office visit would be appropriate to address any identified problems.

  1. Wording has been added to document that the provider has:
  • Identified what components were missing from a comprehensive preventive medicine visit that was performed virtually
  • That those gaps were discussed with the patient/caregiver
  • That you have discussed how to close those gaps in the future

Identified gaps from performing comprehensive well visit in virtual environment, discussed with patient/caregiver including how to close those gaps when safe to do so in an in-person follow-up office visit.

  1. Items of the physical exam that cannot be performed virtually have been removed (for example: checking red reflexes, for hip range of motion, any auscultation or palpation language).