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Albany, NY (WorkersCompensation.com) -- Even before the pandemic, telehealth was catching on as an economical and effective way to provide treatment to injured workers, and it continues to become an entrenched part of the "new normal" in many states, including New York.
So, what are the rules, requirements, and definitions regarding telehealth and workers' compensation in the Empire State? The following chart breaks it down.
| Topics | Explanations |
| Definition of "telehealth" | Telehealth is treatment by physicians, podiatrists, psychologists, nurse practitioners, physician assistants, and licensed clinical social workers authorized by the Chair to provide treatment and care under the Workers’ Compensation Law using two-way audio and visual electronic communication, or audio only. |
| In-person availability | When rendering medical treatment or care via telehealth, an authorized medical provider must be available for an in-person clinical encounter with the claimant should such in-person encounter be medically necessary. This means the authorized medical provider must be able to meet the claimant at the authorized medical provider’s office within a reasonable travel time and distance from the claimant’s residence. |
| Billing | --> Authorized medical providers shall bill using the applicable Evaluation and Management code 99212 using Modifier 95 when services are rendered by telehealth using two-way audio and visual communication. --> When services are rendered by audio only, the authorized medical provider shall use Modifier 93. --> Place of service code 10 shall be used when services are rendered while patient is in their home. -->Place of service code 02 shall be used when services are rendered while patient is in a healthcare setting that is not their home. --> When completing the report of treatment, the authorized medical provider shall identify the address from which they rendered medical care via telehealth as the authorized medical provider’s business address. |
| Treatment via telehealth | Treatment may be rendered by telehealth following an initial in-person clinical encounter when medically appropriate and subject to the following restrictions: Acute and Subacute Phases of Injury or Illness Within the first three months following the date of injury or illness, use of telehealth shall be at the clinical discretion of the treating physician, podiatrist, nurse practitioner, or physician assistant, except that at least every third clinical encounter must be an in-person assessment by the treating physician, podiatrist, nurse practitioner, or physician assistant. Chronic phase of injury or illness When more than three months has passed from the date of injury or illness, use of telehealth shall be at the clinical discretion of the treating physician, podiatrist, nurse practitioner, or physician assistant, except that there must be an in-person assessment by the treating physician, podiatrist, nurse practitioner, or physician assistant, no less than every three months unless or until such provider has determined the patient has reached maximum medical improvement and has stated that the impairment or disability status is permanent and unlikely to change. Injury or Illness at MMI When the claimant is in the chronic phase of injury or illness and the treating physician, podiatrist, nurse practitioner, or physician assistant’s opinion is that the claimant has reached MMI and the patient’s impairment or disability status is permanent and unlikely to change, use of telehealth shall be at the discretion of the treating physician, podiatrist, nurse practitioner, or physician assistant, except that there must be an in-person assessment by such provider at least annually. Treatment by Board-Authorized Psychologists and Licensed Clinical Social Workers This treatment may be rendered when medically appropriate using the following codes: (1) New patient evaluation and management codes 99201-99204 (2) Psychotherapy combination codes and crisis codes 90832-90834, 90836-90840, 90853 (3) Group therapy: 90853 |
| Number of patients in group therapy | The number of patients participating in a group therapy session via telehealth shall not exceed the number that would otherwise be permissible if the group therapy session had been held in person and does not require that every participant in the group therapy session be a workers’ compensation claimant. |
| Remote behavioral health visists | Remote behavioral health visits should be limited to those situations when there is no benefit to in-person services or when an in-person office visit poses an undue risk or hardship on the patient. The reason for the use of a remote telehealth visit should be documented with each use of a telehealth visit. |
| Chiropractors, acupuncturists, physical therapists, and occupational therapists | This type of treatment may not be rendered via telehealth |
| Definition of "medically appropriate for telehealth" | Medically appropriate for telehealth means that an in-person physical examination of the claimant is not needed in order to assess the claimant’s clinical status, need for further diagnostic testing, appropriate treatment, or the determination of causal relationship or level of disability. |
| Factors where an in-person physical examination may not be necessary | Treatment by telehealth may be medically appropriate for: (1) Management of chronic conditions where the Authorized Medical Provider has previously conducted a medically appropriate and comprehensive in-person assessment of the patient and condition and is fully familiar with the applicable medical history. (2) Discussion of test results. (3) Counseling about diagnostic and therapeutic options. (4) Dermatology, for visits not requiring palpation or biopsy of a lesion to accurately diagnose or treat the condition. (5) Prescriptions for medication. (6) Nutrition counseling. (7) Mental health counseling, for which in-person assessment of body movements, postures, and other nonverbal cues is not needed for accurate diagnosis, treatment, or interim assessment of a condition or the potential adverse side-effects of a medication. (8) Other clinical scenarios as may be prescribed in Medical Treatment Guidelines or other related Board communications |
| Factors that indicate an in-person physical examination is necessary | Telehealth is not medically appropriate for: (1) Health concerns that require a procedure. (2) Abdominal pain, chest pain, clinically altered mental status, any situation in which it appears the claimant may pose a risk to themselves or others, severe headache, signs or symptoms of a stroke, or any other clinical presentation that is generally accepted as requiring in-person, emergent or urgent medical assessment, and for which in-person resources (e.g. regional hospital emergency departments or free-standing urgent care centers, as may be clinically appropriate) are readily available. (3) Eye or vision complaints. (4) Highly nuanced or multiple complex health concerns requiring an in-person examination to assess subtle interactions between co-morbidities or medications. (5) Any situation in which an in-person physical exam might reasonably impact the accuracy, quality, or certainty of the authorized medical provider’s assessment, treatment, or recommendations. (6) Any situation where an in-person physical examination is needed to assess disability or range of motion, including but not limited to strength testing, formal range of motion testing, assessment of joint stability, nuanced orthopedic and/or neurologic testing, spirometry or pulmonary function testing, or exercise tolerance testing. (7) Any physical therapy, occupational therapy, or chiropractic services utilizing physical modalities other than instruction on range of motion or strengthening exercises. (8) Any other clinical scenarios as may be prescribed in Medical Treatment Guidelines or other related Board communications. (9) Assessing of causal relationship for an injury or illness unless an in-person physical examination is not necessary to make the determination of causal relationship. In that case, the authorized medical provider must specifically articulate in the medical record why an in-person examination was not necessary in order to make a determination of causal relationship. |
| Procedures that are never medically appropriate for telehealth | (1) Urine drug testing. (2) the initial prescription of long-term medications or follow-up monitoring of those medications without periodic in-person evaluation. (3) Where the nature of treatment set forth in the Medical Treatment Guidelines necessitates an in-person examination. (4) Assessment of permanent disability. (5) Any other clinical scenarios as may be outlined by the Board in Medical Treatment Guidelines or other related Board communications. (6) The patient lacks suitable technology or equipment necessary to conduct the telehealth visit. (7) The patient has physical and/or cognitive challenges that would be a barrier to an effective telehealth visit without the assistance of another individual. (8) The patient has expressed a preference for an in-person visit, as well as a willingness and capability to travel to an in-person visit. |
| Independent Medical Examinations | IMEs are not treatment under the Workers’ Compensation Law. Accordingly, IMEs may be conducted via telehealth when all parties of interest consent to such telehealth examination, and the independent medical examiner is not offering an opinion on permanent impairment. |
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About The Author
About The Author
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Frank Ferreri
Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.
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