The Financial Implications of Telehealth Visits Within a Hand and Wrist Surgery Clinical Practice During the COVID-19 Pandemic

ABSTRACT Purpose Telehealth use is likely to increase as a result of practice changes during the COVID-19 pandemic, though the overall picture surrounding the billing, coding, and continued insurance coverage of these visits remains uncertain. The purpose of this study was to identify potential financial implications of continued telehealth use in hand and wrist surgery clinical practice. Methods Two hundred telehealth visits were randomly selected and matched 1:1, based on primary diagnosis code, to in-person visits. Medical and billing records were reviewed to compare visit complexities, total visit charges, work relative value units (wRVUs), and approved insurance reimbursement. Postoperative visits, and visits with radiographic evaluation were excluded. Results Level 4 visits were more common with in-person encounters versus telehealth (11.5% versus 2.5%) and Level 1 and 2 visits were more common with telehealth (14.5% versus 6.5%). Twenty-seven in-person visits (13.5%) had at least one additional procedure code billed. The mean total visit charge was 26.3% less in telehealth compared to in-person. Based on primary procedure code alone, the sum of wRVUs was 15.1 points less in the telehealth cohort compared to in-person (per visit average = 1.1 telehealth versus 1.2 in-person). The 28 additional services provided during in-person visits accounted for an added 20.7 wRVUs. Unpaid claims were more common among telehealth encounters (8.5% versus 3.5%). Conclusions Higher complexity visits and visits with additional procedural codes billed were more common with in-person visits. This led to a lower number of total wRVUs and lower total visit charges among the included telehealth visits compared to matched in-person controls.