Diagnoses per Encounter by Telephone, Televideo, and In-Office Visits

We sought to determine if there are differences between number of International Classification of Disease-10 (ICD-10) codes per visit before and after COVID-19 when comparing in-office visits and between telemedicine vs in-office visits, toward the goal of determining value of telemedicine visits relative to in-office visits.

We did a chart review study assessing the number of ICD-10 codes noted by providers at a large academic medical institution in 2019 and 2020. Only in-office visits were reviewed in 2019. The focus of analysis was on individual patient visits per visit type; however, a subset of patients who had visits in both 2019 and 2020 were also analyzed. We compared mean number of diagnoses for encounter types using encounter, billing and coding data.

We analyzed 211,829 patient encounters. For 2020, 73% were in office. Mean number of diagnoses per encounter for 2019 was 2.65 (in office only), compared with 3.04 in office, 2.76 telephone, and 2.48 televideo for 2020.

We found an increase in the number of diagnoses addressed during in-office visits from 2019 to 2020. When looking at diagnoses managed per visit, all 3 types of visits had similar complexity. These results may guide future reimbursement policy for telemedicine visits.