Use of Telemedicine in the Evaluation of Patients with Mast Cell Activation Syndrome

Eighteen months ago, our office began evaluating patients for Mast Cell Activation Syndrome (MCAS). Patients present with multiple complaints and co-morbidities, often requiring lengthy record reviews. To manage this volume of requests, our team developed an approach that leverages telemedicine for new and established patients. We thus found ourselves capable of determining whether our approach improved care and maintained satisfaction. We employ a three-pronged approach. First, we request records from providers, after which summaries are prepared and billed ahead of initial visits. We then schedule a telemedicine visit with patients to review records and determine subsequent treatment steps. The third step is a mandatory office visit that includes a detailed physical exam and review of ordered scans and laboratory. Subsequent treatment interactions occur via telemedicine or in-office, as dictated by patient preference and office availability. Referring providers sent records prior to initial interaction, usually a telemedicine visit. Telemedicine evaluations were elected primarily due to distance from the office (> 2 hrs. travel in state or out-of-state). Patient satisfaction was approximately 90% with this approach. Compliance with treatment was encouraging considering insurance coverage, concern for adverse drug effects or satisfaction with previous regimens. Reimbursements for pre-visit records review (99358, 99359), consultant level (99244, 99245), new level (99204, 99205) or established level (99214, 99215) with extended time (99354) were acceptable. Telemedicine for MCAS evaluation proved useful for initial and follow-up visits with satisfactory patient acceptance and outcomes. Our three-pronged approach for patients with complex disorders enhanced their evaluation and continuing care.