Name of the Procedure:

Remote In-Home Visit for Evaluation and Management of an Established Patient (HCPCS Code G9486)

Summary

This procedure involves a healthcare provider evaluating and managing an established patient remotely, within their home. It's designed for cases where patients might find it difficult to visit a healthcare facility and is typically conducted through video conferencing technology.

Purpose

Medical Conditions or Problems it Addresses:

• Chronic disease management (e.g., diabetes, hypertension)
• Acute health issues (e.g., minor infections, exacerbation of chronic conditions) ##### Goals or Expected Outcomes:
• Improved access to healthcare
• Timely intervention in chronic or acute health issues
• Enhanced patient comfort by receiving care at home

Indications

Specific Symptoms or Conditions:

• Limited mobility
• Chronic conditions requiring periodic checks
• Acute health issues manageable outside a hospital setting ##### Patient Criteria:
• Established patients with a previous in-person consultation
• Enrollment in a Medicare-approved CMS Innovation Center demonstration project

Preparation

Pre-procedure Instructions:

• Ensure a reliable internet connection
• Gather any recent medical records or medications ##### Diagnostic Tests or Assessments:
• Possible submission of recent vital signs, like blood pressure or glucose levels, if applicable

Procedure Description

Steps Involved:

1. Schedule the remote visit via phone or healthcare portal.
2. Patient logs in to the video conferencing platform at the scheduled time.
3. Healthcare provider conducts a problem-focused history by asking relevant questions.
4. Physical examination, if applicable, through visual cues and patient-reported symptoms.
5. Provider discusses management plan, including medications, lifestyle changes, or further tests. ##### Tools and Equipment:
   • Computer, tablet, or smartphone with camera and microphone
   • Secure video conferencing software ##### Anesthesia or Sedation:
   • Not applicable

Duration

• Typically lasts 15-30 minutes.

Setting

• Performed in the patient's home, using remote communication technologies.

Personnel

• Primary healthcare provider (e.g., physician, nurse practitioner)
• Technical support, if needed

Risks and Complications

Common Risks:

• Miscommunication or misunderstanding due to remote setting ##### Rare Complications:
• Technical issues disrupting the consultation
• Potential for missed diagnosis due to lack of physical examination

Benefits

Expected Benefits:

• Greater convenience
• Immediate access to healthcare advice and management ##### Realization Time:
• Benefits such as improved health monitoring can be immediate, while others, like chronic disease management, may take longer.

Recovery

Post-procedure Care:

• Follow instructions given by the healthcare provider
• Schedule follow-up visits if needed ##### Expected Recovery Time:
• Not applicable ##### Restrictions or Follow-up:
• Follow up as per the healthcare provider's advice

Alternatives

Other Treatment Options:

• In-person clinic visit
• Urgent care or emergency room visit for severe issues ##### Pros and Cons:
• In-person visits allow a thorough physical examination but may be challenging for patients with mobility issues. Remote visits offer convenience but can have limitations in the assessment.

Patient Experience

During the Procedure:

• The patient will typically feel comfortable at home
• Might experience some anxiety or stress related to the technical aspects of the video call ##### After the Procedure:
• Generally no discomfort; follow up on care plan as needed ##### Pain Management and Comfort Measures:
• Not typically necessary, although emotional support may be provided during the consultation if needed.