Telemedicine Delivery and Successful Reimbursement in Toxicology.

Introduction: Telemedicine and its use in medical toxicology have existed for some time. There are varied definitions, but existing ones center on using currently available forms of audio, video, and internet communications to provide "real-time" patient care. Definitions have historically limited reimbursement but recently expanded CMS guidelines have improved this. Here we describe our experience with telemedicine and reimbursement.

Methods: A retrospective study was conducted of all toxicology and billing reimbursement for fiscal year 2016 for a solo Medical Toxicology service. Clinical identifiers were used to match telemedicine consults to hospital financial databases and then removed. Telemedicine consults were isolated, quantified, and described.

Results: A total of 16 telemedicine consults were conducted. Average age was 37.2 (range 2 months-82 years). Gender was evenly split at 8:8. Twenty-five percent were pediatric consultations. The main purposes of consultation were as follows: diagnosis and disease management in drug ingestion, triage assistance, clearance consults, antidote administration, and buprenorphine induction. At the time of the work, $1896.00 for 9.3 h of teletoxicology services was reimbursed equating to an hourly reimbursement rate of $203.90/h.

Limitations: Our data was obtained from a toxicology practice with a surrounding infrastructure dedicated to telemedicine. All sites may not have this robust ancillary support. Furthermore, not all states have reimbursement mandates such as New York State.

Conclusion: To our knowledge, this is the first published work describing pilot data in the successful reimbursement for Medical Toxicology services delivered via telemedicine. Toxicology via telemedicine represents a great opportunity for advancing the practice of toxicology in an economically feasible way, particularly in rural or underserved areas.