Peter Yellowlees, MBBS, MD, is the Chief Wellness Officer for the University of California Davis Health in Sacramento California. He holds the Alan Stoudemire Endowed Chair of Psychiatry at the University of California Davis, where he is also Vice-Chair for Faculty Development in the Department of Psychiatry.
Relevant to this interview, he is a Past President of the American Telemedicine Association and a member of the American Psychiatric Association and University of California’s workgroups on Telepsychiatry.
Dr. Yellowlees is an expert in physician health and telepsychiatry. He chairs the UC Davis Health System Wellbeing Committee and has many physicians as patients. He has provided clinical consultations to patients on Indian Health reservations via telemedicine for over fifteen years.
Dr. Yellowlees is considered to be one of the leading experts on Telepsychiatry in the world. He is a co-editor of the book Telepsychiatry and Health Technologies: A Guide for Mental Health Professionals
Dr. Yellowlees is presently working on the development and validation of asynchronous telepsychiatry, automated translation and clinical interpreting systems, internet e-mail and video consultation services and assessment and treatment protocols to improve physician health and wellness.
Dr. Yellowlees has worked in public and private sectors in the USA, Australia, and the UK, in academia, and in rural settings. He has published eight books and over 200 scientific articles and book chapters. He has recently written two books on physician health and wellbeing, Physician Suicide: Cases and Commentaries and Physician Wellbeing: Cases and Solutions both published by the American Psychiatric Association Publishing, Inc.
Dr. Yellowlees was interviewed by Rajnish (“Raj”) Mago, Editor of Simple and Practical Medical Education on Monday, March 16, 2020, on the topic of telepsychiatry.
Part 1:
Part 2:
For tips on telepsychiatry on this website, please see the following articles:
An introduction to telepsychiatry
A comparison of telepsychiatry platforms
Related Pages
Telepsychiatry: Your questions answered
Telepsychiatry: Comparison of platforms
Interviews with experts: Index and links
What are the BEST books on each topic related to psychiatry/ mental health?
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This was a fantastic wealth of knowledge shared! Thank you both so much!
Is there any online resources that can update us on Telepsychiatry billing codes with CMS and private insurances especially during times of COVID; How would we bill for family therapy ? How do you prevent malingering patient for secondary gain?
Hi Diane: Billing codes for telepsychiatry (and other telepsychiatry issues) are explained on the following page: https://simpleandpractical.com/telepsychiatry/ Regarding malingering, why would that be any different than if we saw the patient in person?
1. I am informed that eCW/Healo has some capacity for telemedicine/telepsychiatry, and apparently patients would be able to log in via an app on their phone from home without even coming into the clinic. Does this sound correct to you? The model of telemedicine I was aware of involved having the patient log in to the visit at a clinic with a nurse or someone else present who could facilitate the visit, obtain vitals, etc., whereas the doctor was remote. However, obviously with current concerns around COVID it is desirable for the patient to be able to complete the visit at home. How would that be able to be billed?
Also if you are familiar with this platform, do you have any specific concerns or comments about this particular platform?
2. Our clinic has discussed just calling patients on the phone (starting in the next 1-2 days) for a period of time as a transitional step before we get eCW/Healo up and running or for patients who are not able to use the app. We were intending mainly to triage whether there is any urgent issue as well as to offer refills and to ask for them to reschedule since they had been scheduled for an appointment and it is being canceled with the clinic closing due to concerns around COVID. Are there any codes that could be reimbursed for these calls or are they not billable?
3. I have ordered your book and perhaps something is in your book. However, are there any good templates you can provide for telemedicine followup visits appropriate for a general adult outpatient psych clinic?
Thanks very much for any input you can offer!
1. Yes, some EMRs have telepsychiatry built into them.
2. Medicare used to have the requirement that patients should come to a healthcare facility for telepsychiatry, but that has been waived during the current healthcare emergency. Patients can be seen at home.
3. Regarding phone calls, there are billing codes for them, but reimbursement (if done) is at a much lower level than for E&M visits.
4. Notes for telepsychiatry visits are the same as for in-person visits except that you would note that informed consent for telepsychiatry was obtained and certain physical examination items cannot be done.
Can the patient record such a session and use what is being said during the session out of context?
Most software does not allow patients to record the call without our permission and/or displays a notice that the call is being recorded. But, there are easy ways in which patients could get around this and record the call. That is true. I don’t think there is any way to prevent this being done by a patient who is technically savvy. But, even in in-person visits, it is very easy for patients to record the audio of the session on their smartphone, right? Hopefully, clinicians are not saying anything that they would be embarrassed to hear played back from a recording.
I am in New York and see residents at an Assisted Living Facility. Codes I might typically bill are 90792 for new evals and 99335 for follow ups. Am I able to bill if seen via telepsych (I use SecureVideo.com for HIPAA compliance) and if so, what equivalent codes would I use? Will reimbursement be reduced? Thanks in advance for your help!
The question of billing and reimbursement, including billing codes, has been answered on the following page: https://simpleandpractical.com/telepsychiatry/
What are the telepsychiatry laws (CMS) regarding a physician located on a US military base?
I wonder if they will change the restriction that prevents you from seeing new patients by telepsychiatry and help patients get reimbursed by insurance. My understanding is that you must have seen them within 3 years. Also, will they waive the restriction on prescribing patients you have never seen face-to-face controlled substances. This may be risky, but there will be need if this drags out.
I am in a solo practice and do not bill insurance. I need a HIPAA compliant software urgently to visit with my existing and new patients locally in Texas. What is a good basic no frill tele psychiatry platform? I use Valant for my e prescribing and documentation. Thank you.
Have you used telepsych in the nursing home setting, and if so, what have you found to be the best way to set this up? Do staff from the facility help or do you have an assistant on site going to patients’ rooms?
Are there any states which require you BOTH be licensed in the state where the patient is (originating site) AND the state where you are physically located (distant site)? Are there any states currently that require the provider physically be located in the United States to treat patients in the state where the provider is licensed and the patient is (I know some insurance companies require this – I’m just curious about the states)?
Please ask Dr. Yellowlees to review billing basics: Do we use the same codes as in the office, or are there special codes for telepsychiatry? Is there a modifier we need to use? What is the place of service code?
Will Medicare allow us to bill for telepsychiatry is patient is at home? I saw one document suggesting Medicare required the patient to be at another health care site in order to bill, but I don’t know if this is current.
To Marina Goldman, who reported some videoconferencing sites crashing, I suggest trying thera-link.com. I have not tried it myself yet, but they have excellent reviews and responded to my inquiries quickly. After a free trial, they charge $45/month for unlimited visits. I’m not surprised the the others, which provide free service without a time limit, are crashing.
Which platforms work the best to conduct telepsych or teletherapy through that would meet HIPPA standards of privacy and any guidelines or regs that CMS states or the individual states (such as PA, DE,NY, NJ) have in regards to providing telepsych
I have college students who are in school in my area, but now have scattered to their homes, many in states in which I do not have a license. How can I see them via video and prescribe stimulants for their stable ADHD? I know current law states I have to have a license in the state where the patient is during the video appointment.
What’s the latest information on Medicare? Will they cover telephone sessions or only video? Many of my elderly patients can’t handle the technology of a video conference. Suggestions?
This may be specific to Virginia. My practice manager tells me that we have to apply to the Board of Pharmacy to issue a “Controlled Substances Registration” with approval to do Telemedicine. In addition, the DEA has to issue a similar certificate before we can proceed. Is this necessary for psychiatric practice or specific to doctors prescribing Suboxone? Secondly, is this certificate site specific? For example, for an assertive community treatment setting that operates through 2 different offices, do i have to apply twice for these certificates?
I am having trouble convincing people to get set up at their homes with a camera or using their smart phones. They simply say “can’t we just do a telephone session?” I say yes, but I wonder about the long-term. Going forward, I would like to be able to see them.
Do telepsych visits require authorization by the insurances? Which health insurances cover the telepsych visits at this time?
How do you address important assessments such as blood pressure, weight and AIMS in telepsych?
Is there a different code for this?
Do most insurances cover telepsych?
He explains BP, weight and AIMS in the interview.
Currently, the VSEE and Doxy.me platforms are crashing. Looking for alternatives
I have used SecureVideo.com for about 3 years and have not had any issues at all.
Will this be an interview we can follow in live time or will it be available on SPMH tomorrow?
Thanks for this very timely interview!
Dr. Rayfield: The interview with Dr. Yellowlees about telepsychiatry will NOT be live. It will be recorded and made available to everyone, probably by tomorrow, March 17, 2020, on this page. We will email you once the recording is available.
We are attempting to implement telepsych during the quarantine here in Philadelphia, is it standard to have a staff person specifically inthe room with each patient or does someone just need to be close by for safety reasons? We are having conflicting messages reported to us as this is new for our clinic.
Looking forward to learning from you. Please advise protocol differences among different populations, for example addiction patients. Would you send them to a lab for urine drug screening. What else can you do besides talking and prescribing? (biological data collection such as vital signs, etc).
How do we handle controlled substance prescribing via telepsychiatry in the context of Ryan Haight Act? Would this pandemic constitute an exception or do we need to wait for HHS secretary/DEA to give the okay?
What exactly do the CMS guidelines to allowing interstate practice mean? How does this affect private billing and how are state boards of medicine reacting?