We’re moving more TKA/THA to same-day discharge with adductor canal and IPACK blocks plus an opioid-sparing plan, and added a 48-hour video wound check and 7 days of daily app check-ins. Early numbers from September: 30-day ED returns down from 4.0% to 1.6%; are other ortho PAs trying similar postoperative touchpoints, and how are you handling billing (RTM vs standard telehealth)?
I’ve had good luck billing the 7‑day app check-ins as RTM when the app logs ‘therapeutic adherence’ plus pain scores — enroll with 98975 and count your interactive time toward 98980; small caveat: some MA/commercial plans still nudge us to 99212 for the 48‑hr video if we change meds — are you seeing the same?
@OP we added a 36-hour “buckling check” video after adductor canal blocks: patients do a supported 10-step march and one hallway pass on camera, and if there’s wobble we trigger same-day home PT instead of risking an ED visit. For billing, we keep that separate from the 48-hour video wound check in the global and reserve RTM for the 7-day app data when we meet 98980 time, but watch that med changes during the call can push it into telehealth.
We shifted our first touchpoint to 30–36 hours because the ACB/IPACK tends to wear off then; a quick 5‑minute video “med reset” there cut the 2 a.m. pain calls and kept folks out of the ED. We still do your “48-hour video wound check,” but it’s a photo plus a 30‑second peek at the dressing, not a full visit. Billing: surgeon‑led check‑ins stay inside the 90‑day global; we run the adherence/pain‑score pathway through PT as RTM (98975/98980) to avoid global conflicts — watch MA plans that still bundle RTM. @OP are you seeing the 36‑hour pain bump, or are your opioid‑sparing ramps covering it?
Quick example: we added a day‑1 evening sit‑to‑stand plus 10 steps video to catch quad shutdown and tweak brace or cane use before the nighttime stumble, which cut after‑hours pain calls and one near‑fall. For billing, if I modify the HEP within the platform I count it toward RTM (98980/98981), but if I change meds or DME I switch to a brief video visit (99212‑95) — MA plans here often bundle RTM, so we check eligibility first. @OP are your payers accepting RTM when you log adherence and pain without a documented exercise progression?