Getting started with telemedicine: A 4-step approach


Stephen Canon, MD, Jonathan Linkous of the American Telemedicine Association, and Peter N. Bretan, Jr., MD, recommend urologists take these steps before committing to a telemedicine approach.

Urologists interested in using telemedicine for patient care should do so with their eyes wide open, according to Stephen Canon, MD. Dr. Canon, Jonathan Linkous of the American Telemedicine Association, and Peter N. Bretan, Jr., MD, recommend urologists take these steps before committing to a telemedicine approach.

Step one

Understand the laws and regulations that impact telemedicine in your state.

While some states embrace telemedicine, others do not. The American Telemedicine Association offers two free and up-to-date state-by-state report cards on telemedicine. One is a gap analysis on coverage and reimbursement; the other focuses on physician practice standards and licensure.

Step two

Mr. LinkousMake sure you have access to a telemedicine technology and system infrastructure.

“It’s very important to protect privacy, but there isn’t a HIPAA-compliant technology. It’s a process,” Linkous said. “The technology is pretty ubiquitous, but if you’re providing care that is directly used to diagnose or treat a patient, then of course, you’ll have to use something that is approved by the FDA. Other than that, it’s pretty wide open. Interactive video is used quite often. It could be something simple that’s computer based or something complicated, like a private network. It really depends on the applications.”

Dr. Bretan provides telemedicine care from his laptop, by controlling an onsite robot. He says the robots, which actually go into patients’ rooms, are at many hospitals that don’t have access to local specialists. A video, “The Robot Will See You Now,” explains the process.

Related: Telemedicine’s use may expand beyond rural settings

In Arkansas, Dr. Canon has access to the Antenatal and Neonatal Guidelines Education and Learning System (ANGELS), a consultative service for family practitioners, obstetricians, pediatricians, and neonatologists in the state. Pediatric urologists at Arkansas Children’s Hospital are regularly consulted for cases of prenatal hydronephrosis and other conditions.

NEXT: Understand how to bill for telemedicine

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Step three

Dr. CanonUnderstand how to bill for telemedicine.

States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes, and modifiers (GT, U1-UD) in order to identify, track, and reimburse for telemedicine services, according to the Medicaid website.

“Billing for telemedicine primarily involved the addition of a GT modifier to the initial or follow-up visits, which are used every day by urologists,” Dr. Canon said.

The American Telemedicine Association offers a reimbursement course.

Step four

Test the telemedicine waters.

“It’s a little bit of a shock to the infrastructure when you have a patient that is mixed in the schedule that is not going to be there in person, in the middle of a full day of clinic patients,” Dr. Canon said.

One tip: To better determine if they could and would use telemedicine to care for patients, Dr. Canon and colleagues tested the use of the technology for care during the 90-day global period, so billing was out of the equation.

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