|
TELEMEDICINE VISIT
|
|
|
FORM OF TELEMEDICINE
|
|
|
LOCATION OF GUEST
|
|
|
X ---------------------------- E/M CODING ---------------------------- X
|
|
|
LEVEL 4
|
99080 - PAPERWORK COMPLETION
|
|
LEVEL 5 - TIME ONLY
|
LEVEL 3 - MEDICAL DECISION MAKING ONLY
|
|
LEVEL 4
|
|
|
MEDICAL DECISION MAKING
|
|
|
TIME
|
|
|
X --------------------------- LEVEL 4 - TIME --------------------------- X
|
|
|
NEW vs ESTABLISHED
|
|
|
ESTABLISHED GUEST (30 - 39 Minutes)
|
MINUTES - Established
|
|
NEW GUEST (45 - 59 Minutes)
|
MINUTES - New
|
|
|
|
|
X --------------------------- LEVEL 5 - TIME --------------------------- X
|
|
|
NEW vs ESTABLISHED
|
|
|
ESTABLISHED GUEST (40 - 54 Minutes)
|
MINUTES - Established
|
|
NEW GUEST (60 - 74 Minutes)
|
MINUTES - New
|
|
|
|
|
X -------------- LEVEL 3 - MEDICAL DECISION MAKING -------------- X
|
|
|
NEW vs ESTABLISHED
|
|
|
NEW or ESTABLISHED GUEST - LEVEL 3
|
|
|
PICK 1 AREA OF BODY TREATED TODAY
|
|
|
SPINE
|
UPPER & LOWER EXTREMITY
|
|
NECK
|
SHOULDER
|
|
UPPER / MID BACK
|
HIP
|
|
LOW BACK
|
KNEE
|
|
OTHER
|
OTHER
|
|
OTHER
|
OTHER #1
|
|
|
OTHER #2
|
|
|
ABDOMEN
|
|
|
PELVIS
|
|
|
PTSD
|
|
X --------------- LEVEL 4 - MEDICAL DECISION MAKING -------------- X
|
|
|
NEW vs ESTABLISHED
|
CHOOSE 1 PROBLEM TYPE ADDRESSED AT OV
|
|
NEW or ESTABLISHED GUEST - LEVEL 4
|
ACUTE OR CHRONIC (2 STABLE OR 1 POORLY CONTROLLED)
|
|
ITEM ADDRESSED AT OV
|
CHRONIC (STABLE) X 2 - 1 SPINE LEVEL
|
|
ITEM ADDRESSED AT OV
|
CHRONIC (STABLE) X 2 - 1 AREA (NON-SPINE)
|
|
CHOOSE 1 ITEM ADDRESSED
|
|
|
TREATMENT / DISCUSSION
|
|
|
** 3 UNIQUE SOURCES SINCE LAST OV ** - MEDICAL RECORD REVIEW and/or TEST ORDERED
|
|
|
|
|
|
IMAGING INTERPRETED - DOCUMENT IN "PAIN - CC / HPI"
|
|
|
IMAGING TYPE
|
|
|
IMAGING LOCATION
|
|
|
CHOOSE 1 SPINE LEVEL TREATED
|
|
|
NECK
|
CHOOSE 2 CERVICAL PROBLEMS ADDRESSED TODAY
|
|
|
PROBLEM #1 - Cervical
|
|
|
PROBLEM #2 - Cervical
|
|
UPPER / MID BACK
|
CHOOSE 2 THORACIC PROBLEMS ADDRESSED TODAY
|
|
|
PROBLEM #1 - Thoracic
|
|
|
PROBLEM #2 - Thoracic
|
|
LOW BACK
|
CHOOSE 2 LUMBAR / SACRAL PROBLEMS ADDRESSED TODAY
|
|
|
PROBLEM #1 - Lumbar / Sacral
|
|
|
PROBLEM #2 - Lumbar / Sacral
|
|
CHOOSE 1 BODY AREA TREATED
|
|
|
KNEE
|
|
|
CHOOSE 2 KNEE PROBLEMS ADDRESSED TODAY
|
|
|
PROBLEM #1 - Knee
|
|
|
PROBLEM #2 - Knee
|
|
|
OTHER #1
|
|
|
CHOOSE 2 PROBLEMS ADDRESSED TODAY
|
|
|
PROBLEM #1 - Other #1
|
|
|
PROBLEM #2 - Other #1
|
|
|
OTHER #2
|
|
|
CHOOSE 2 PROBLEMS ADDRESSED TODAY
|
|
|
PROBLEM #1 - Other #2
|
|
|
PROBLEM #2 - Other #2
|
|
|
PICK 1 AREA OF BODY TREATED - UNSTABLE CHRONIC & ACUTE
|
|
|
PICK 2 AREA OF BODY TREATED - STABLE CHRONIC
|
|
|
SPINE
|
UPPER & LOWER EXTREMITY
|
|
NECK
|
SHOULDER
|
|
UPPER / MID BACK
|
HIP
|
|
LOW BACK
|
KNEE
|
|
OTHER
|
OTHER
|
|
OTHER
|
OTHER #1
|
|
|
OTHER #2
|
|
|
ABDOMEN
|
|
|
PELVIS
|
|
|
PTSD
|
|
|
|
|
X ------------------------- ICD - 10 CODING -------------------------- X
|
|
|
X ----- GENERAL DIAGNOSIS ----- X
|
X ------- MUSCLE / ABDOMEN / CHEST ------- X
|
|
GENERAL DIAGNOSIS
• • •
|
MUSCLE / ABDOMEN / CHEST
• • •
|
|
X ------- SPINE ------- X
|
|
|
CERVICAL
|
|
|
X ------- CERVICAL ------- X
|
|
|
CERVICAL - M43 / M47 / M50
• • •
|
Spondylosis / Disc Disorder / Spondylolisthesis
|
|
CERVICAL - M48 / M54 / M96 / M99 / S13 / S16
• • •
|
Radiculopathy / Cervicalgia / PLS / Strain & Sprain / Stenosis
|
|
THORACIC
|
|
|
X ------- THORACIC ------- X
|
|
|
THORACIC - M43 / M47 / M51
• • •
|
Spondylosis / Disc Disorder / Spondylolisthesis
|
|
THORACIC - M41 / M48 / M54 / M96 / M99 / S23 / S29
• • •
|
Radiculopathy / Pain / PLS / Strain & Sprain / Stenosis / Scoliosis
|
|
THORACIC COMPRESSION FRACTURE
|
|
|
THORACIC COMPRESSION FRACTURE
• • •
|
|
|
LUMBOSACRAL
|
|
|
X ---------- LUMBOSACRAL ---------- X
|
|
|
LUMBOSACRAL / SIJ - M43 / M46 / M47 / M48 / M99
• • •
|
Sacroiliitis / Spondylosis / Stenosis / Spondylolisthesis / Spondylolysis
|
|
LUMBOSACRAL - M41 / M51 / M53 / M54 / M96 / S33 / S39
• • •
|
Radiculopathy / Disc Disorder / Pain / PLS / Coccydynia / Strain & Sprain / Scoliosis
|
|
LUMBOSACRAL FRACTURE
|
|
|
LUMBOSACRAL FRACTURE
• • •
|
|
|
X ------- OTHER ------- X
|
|
|
NEUROPATHY
|
|
|
X -------- NEUROPATHY -------- X
|
|
|
UPPER EXTREMITY - NEUROPATHY
• • •
|
HEAD / GENERAL / INTERCOSTAL / FACIAL / HERPETIC - NEUROPATHY
• • •
|
|
LOWER EXTREMITY - NEUROPATHY
• • •
|
|
|
|
|
|
TENDON
|
X -------- TENDON -------- X
|
|
|
UPPER EXTREMITY - TENDON
• • •
|
|
|
LOWER EXTREMITY - TENDON
• • •
|
|
JOINT / BURSA / TENDON
|
|
|
X ---------- JOINT / BURSA / TENDON ---------- X
|
|
|
UPPER EXTREMITY - JOINT / BURSA
|
SHOULDER / ELBOW - JOINT/BURSA
• • •
|
|
|
WRIST / HAND - JOINT/BURSA
• • •
|
|
LOWER EXTREMITY - JOINT / BURSA
|
HIP - JOINT/BURSA
• • •
|
|
|
KNEE / ANKLE / FOOT - JOINT/BURSA
• • •
|
|
JOINT - CHEST / TMJ
|
CHEST / TMJ - JOINT
• • •
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
REPORT
|
|
|
Level 4 Time
|
|
|
Level 4 - Established Time
|
|
|
Level 4 - New Time
|
|
|
Level 4 time info
|
|
|
Level 5 Time
|
|
|
Level 5 - Established Time
|
|
|
Level 5 - New Time
|
|
|
Level 5 time info
|
|
|
Level 3 Medical Decision Making Only
|
|
|
Level 4 Medical Decision Making
|
|
|
Items Addressed at OV
|
|
|
Chronic / stable - 1 Spine Level
|
|
|
|
|
|
Level 4 - Neck 2 - Problem #1 - 1 Spine Level
|
|
|
Level 4 - Neck 2 - Problem #2 - 1 Spine Level
|
|
|
|
|
|
Level 4 - Upper/Mid back 2 - Problem #1 - 1 Spine Level
|
|
|
Level 4 - Upper/Mid back 2 - Problem #2 - 1 Spine Level
|
|
|
|
|
|
Level 4 - Low Back 2 - Problem #1 - 1 Spine Level
|
|
|
Level 4 - Low Back 2 - Problem #2 - 1 Spine Level
|
|
|
2 Stable / 1 Poorly Controlled
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Level 4 - Knee - Problem #1 - 1 Body Area
|
|
|
Level 4 - Knee - Problem #2 - 1 Body Area
|
|
|
|
|
|
Level 4 - Other #1 - Problem #1 - 1 Body Area
|
|
|
Level 4 - Other #1 - Problem #2 - 1 Body Area
|
|
|
|
|
|
Level 4 - Other #2 - Problem #1 - 1 Body Area
|
|
|
Level 4 - Other #2 - Problem #2 - 1 Body Area
|
|
|
Telemedicine 1
|
|
|
Telemedicine 2
|
|
|
DO NOT TOUCH!
|
|
|
IMAGING INTERPRETATION
|
|
|
TEST ORDER and/or MEDICAL RECORD REVIEW - 3 UNIQUE SOURCES - SINCE LAST PAIN OV
|
|
