Name of the Procedure:

Remote In-Home Visit for Evaluation and Management of an Established Patient (HCPCS Code: G9488)

Summary

This procedure involves a healthcare provider conducting a remote evaluation and management visit for an established patient in their home environment. It is part of a Medicare-approved CMS Innovation Center demonstration project and requires at least two of the following three key components: a detailed history, a detailed examination, or medical decision-making of moderate complexity.

Purpose

Medical Conditions or Problems It Addresses

• Chronic disease management (e.g., diabetes, hypertension)
• Acute illnesses or exacerbations of chronic conditions
• Follow-up after hospitalization
• Medication management
• Overall health monitoring and management

Goals or Expected Outcomes

• Improved access to healthcare services
• Enhanced patient convenience and comfort
• Early detection of potential health issues
• Better adherence to treatment plans

Indications

Symptoms or Conditions Warranting the Procedure

• Difficulty accessing in-person healthcare services
• Chronic health conditions requiring regular monitoring
• Recent discharge from a hospital or other healthcare facility
• Needs ongoing medication or treatment adjustments

Patient Criteria

• Must be an established patient with a prior relationship with the healthcare provider
• Must be part of a Medicare-approved CMS Innovation Center demonstration project

Preparation

Pre-procedure Instructions

• Ensure reliable internet connectivity and access to the required technology (e.g., webcam-enabled device)
• Gather relevant medical records and a list of current medications
• Prepare a quiet, private space for the visit

Diagnostic Tests or Assessments

• No specific pre-tests are required; however, patients should have recent vital signs and laboratory results available if applicable

Procedure Description

Step-by-Step Explanation

1. Appointment Scheduling: The patient schedules a remote visit with their healthcare provider.
2. Initial Setup: The patient logs into the telehealth platform at the scheduled time.
3. Detailed History: The provider takes a detailed medical history, including recent symptoms and any changes in health status.
4. Detailed Examination: The provider may ask the patient to perform certain physical maneuvers or use devices like a home blood pressure monitor to collect necessary data.
5. Medical Decision Making: The provider reviews the information and makes complex medical decisions about the patient’s ongoing treatment plan.

Tools and Equipment

• Secure telehealth platform
• Webcam-enabled device (computer, tablet, or smartphone)
• Peripheral devices as needed (e.g., blood pressure monitor, oximeter)

Anesthesia or Sedation

• Not applicable

Duration

• The procedure typically takes between 20 to 40 minutes.

Setting

• The patient's home.

Personnel

• Primary Healthcare Provider (e.g., Physician, Nurse Practitioner, or Physician Assistant)

Risks and Complications

Common Risks

• Technical issues such as poor internet connection
• Miscommunication or misunderstanding due to the remote nature

Rare Risks

• Missed diagnosis or delayed treatment due to lack of in-person examination

Management

• Patients should have a follow-up plan for any technical or medical issues encountered during the visit.

Benefits

• Convenience and comfort of being at home
• Immediate access to a healthcare provider
• Reduced risk of exposure to infectious diseases
• Enhanced management of chronic conditions

Recovery

Post-procedure Care

• Follow any specific recommendations provided by the healthcare provider
• Schedule follow-up appointments as advised

Expected Recovery Time

• No physical recovery time needed, as this is a non-invasive consultation

Restrictions and Follow-up

• No specific physical restrictions
• Follow-up plans will vary based on the patient's condition and the outcomes of the visit

Alternatives

Other Treatment Options

• In-person visits to a healthcare clinic or facility
• Telephone consultations
• Email or patient portal messaging

Pros and Cons of Alternatives

• In-person visits: More thorough examination possible but less convenient and higher potential exposure to infectious diseases.
• Telephone consultations: More accessible but lack visual assessment tools.
• Email or patient portal: Good for follow-ups or minor concerns but not suitable for complex issues.

Patient Experience

During the Procedure

• Patients may feel comfortable and relaxed in their home environment
• They should experience minimal discomfort as the procedure is non-invasive

Pain Management and Comfort Measures

• No pain associated, focus is on ensuring patient is comfortable and communication is clear