note to publisheryou may communicate directly with Kim at kpollock@karenzupko.com or mobile 972-953-6644please do NOT publish this email address or phone number] Journal Pre-proof J o u r n a l P r e -p r o o f 2 Abstract The COVID-19 pandemic has quickly and radically altered how Otolaryngologists provide patient care in the outpatient setting. Continuity of care with established patients as well as establishment of a professional relationship with new patients is challenging during this Public Health Emergency (PHE). Many geographic areas are under "stay at home" or "shelter in place" directives from state and local governments to avoid COVID-19 exposure risks. Medicare has recently allowed "broad flexibilities to furnish services using remote communications technology to avoid exposure risks to health care providers, patients, and the community." 1 The implementation of telemedicine, or virtual, services, will help the Otolaryngologists provide needed care to patients while mitigating the clinical and financial impact of the pandemic. The significant coding and billing issues related to implementing telemedicine services are discussed to promote acceptance of this technology by the practicing Otolaryngologist. Of particular importance, outpatient visit Current Procedural Terminology® codes (99201-99215) may be used for telehealth visits performed in real-time audio and video. Journal Pre-proof J o u r n a l P r e -p r o o f This Commentary focuses on Medicare guidance for telemedicine services sinceMedicare is a major payor in most Otolaryngology practices and many non-Medicare payors follow Medicare policies. We hope that Otolaryngologists will embrace this technology currently, as well as for the future, to foster and maintain essential patient care in the office setting. Journal Pre-proof J o u r n a l P r e -p r o o f 4 Definitions: Telehealth vs TelemedicineMany people use the terms "telehealth" and "telemedicine" interchangeably, but the definitions are not the same. Telehealth is a broad term that includes telemedicine as one type of service.The Health Resources and Services Administration (HRSA), of the DHHS, defines telehealth as "the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional healthrelated education, public health and health administration." 2The HRSA goes on to say: "Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services." 3 CMS refers to many remote clinical services at "telehealth visits" as opposed to calling them "telemedicine services". For purposes of this Commentary, we use the term "virtual services" to encompass four types of billable services: 1) telehealth services (Medicare"...

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The novel Coronavirus has created a deadly pandemic that is now significantly impacting the United States. Otolaryngologists are considered high risk for contracting disease, as the virus resides in the nasal cavity, nasopharynx, and oropharynx. While valuable work has been publicized regarding several topics in Rhinology, we discuss other aspects of our specialty in further detail. There are several issues regarding Rhinologic practice that need to be clarified both for the current epidemic as well as for future expected "waves." In addition, as the pandemic dies down, guidelines are needed to optimize safe practices as we start seeing more patients again. These include protocols pertinent to safety, in-office Rhinologic procedures, the substitution of imaging for endoscopy, and understanding the appropriate role of telemedicine. We discuss these aspects of Rhinology as well as practical concerns relating to telemedicine and billing, as these issues take on increasing importance for Rhinologists both in the present and the future. (P.F. Svider).Am J Otolaryngol xxx (xxxx) xxxx 0196-0709/

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