Abstract
BackgroundTelemedicine is the use of telecommunication technology to remotely provide healthcare services. Evaluation of telemedicine use often relies on administrative data, but the validity of identifying telemedicine encounters in administrative data is not known. The objective of this study was to assess the accuracy of billing codes for identifying telemedicine use.MethodsIn this retrospective study of encounters within a large integrated health system from January 2016 to December 2017, we examined the accuracy of billing codes for identifying live-interactive and store-and-forward telemedicine encounters compared to manual chart review. To further examine external validity, we applied these codes and assessed patient and visit characteristics for identified live-interactive telemedicine encounters and store-and-forward telemedicine encounters in a second data set.ResultsIn manual review of 390 encounters, 75 encounters were live-interactive telemedicine and 158 were store-and-forward telemedicine. In weighted analysis, the presence of the GT modifier in the absence of the GQ modifier or CPT code 99444 yielded 100% sensitivity and 99.99% specificity for identification of live-interactive telemedicine encounters. The presence of either the GQ modifier or the CPT code 99444 had 100% sensitivity and 100% specificity for identification of store-and-forward telemedicine encounters. Applying these algorithms to a second data set (n = 5,917,555) identified telemedicine encounters with expected patient and visit characteristics.ConclusionsThese findings provide support for use of CPT codes to perform telemedicine research in administrative data, aiding ongoing work to understand the role of non-face-to-face care in optimizing health care delivery.
Highlights
Telemedicine is the use of telecommunication technology to remotely provide healthcare services
We examined the accuracy of billing codes in identifying telemedicine encounters, the goal of which was to determine the criterion validity of use of these billing codes
Through manual encounter review of these 390 encounters, we identified 75 live interactive telemedicine visits, 158 store-and-forward telemedicine visits, and 157 visits that were not telemedicine
Summary
Telemedicine is the use of telecommunication technology to remotely provide healthcare services. Telemedicine encompasses the use of telecommunication technology to remotely provide healthcare services that support patient care [1]. Telemedicine can take many forms, with some models facilitating live interactive communication between patients and clinicians (“synchronous”) while other models record and send patient information, allowing clinicians to review and respond to this information at a later time (store-and-forward, or “asynchronous”). Both of these models have the potential to overcome geographic barriers and to enhance the timeliness of care. Understanding the use, trends, and impact of telemedicine across multiple specialties and applications is vital to promoting telemedicine use that facilitates more effective, efficient, equitable, and patient-centered care delivery.
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