Welcome back to the connected practice. As physicians, we all know the curbside consult. It happens in the hallway or stairwell, maybe it’s through an unsecured text, or it could be a quick phone call between cases. A colleague is asking you for your expert advice on a complex presentation, unusual lab value, or curious CT finding. It’s not quite a consult. It’s a curbside. You know the lingo. It goes like this: “Hey, do you have a second?” Or, “Hey, let me pick your brain.” Or, “Ah, I got a question.”
It is how we practice medicine. It is how we’ve always taken care of patients. However, there is a problem. That expertise, that high-level cognitive labor is usually uncompensated. It is invisible work. Ironically, it does not have to be. We have CPT codes designed to fix this. They are the interprofessional consult codes, 99446 through 99452. Yet almost no one uses them. And when you do not, you are leaving money on the table. Not because you did not earn it, but because you did not document it and submit it. But that’s way too much work to squeeze into your already packed day, right? There’s no time for that. It’s not worth it, right? Oh well, just another free service that we provide. Sound familiar?
Today on the Connected Practice, part of the Clinician Core podcast series, I want to talk about why these codes are failing us and how we can actually start getting credit for the work that we already do. I’m Dr. Kevin Halow, Co-founder and Chief Medical Officer of Clinician Core. Welcome back again to the connected practice.
As a surgical specialist, a lot of my week is spent at curbsides. Both in-house and outpatient. I’m sure that yours does too. I don’t really mind them. I’ve been doing them since I was a resident. I think that we are trained to do them. After all, it’s just the right thing to do for your colleague. Plus, it keeps you connected and engaged with them. The curbsides have never bothered me because what goes around comes around. You never know when you need that hospitalist who curbsided you last week to lend you a hand today on a post-op, fragile diabetic patient.
But why do we have to do it for free? On paper, CPT 99446 through 99452 are a win. They allow a specialist to bill for their time without the patient needing a face-to-face visit. It also actually sounds like a great way to reduce the referral backlog. And could you imagine collecting 50 bucks for a quick 15-minute consult, curbside, right? Works for me.
However, then the reality sets in and you remember that administrative sludge. See, to bill these, you have to navigate a minefield. There is the 14-day rule. If a specialist has seen the patient recently or sees them in the next two weeks, the consult is bundled, it becomes free work again. There is the consent hurdle. You have to stop your clinical flow to explain to a patient that they might get a bill for a conversation they are not even participating in. What? There is the time tracking. You aren’t just logging a code, you’re tracking cumulative minutes of record review, verbal discussion, and written reports. Then, then you have to go into the EMR system and record it for your coders and billers.
Most physicians know this list all too well. And they decide it’s easier just to give the advice for free. But is it really? Ultimately, that’s just one more weight that lands on your shoulders that you must bear. It’s just another revenue drain that fuels the fires of physician burnout.
I remember a time when there was a debate about whether a laparoscopic cholecystectomy was equivalent to an open cholecystectomy. I also remember a time when we left a drain in every patient who underwent cholecystectomy. I am happy to report that we now know that laparoscopic cholecystectomy is superior to open surgery and we rarely leave drains because they are only needed occasionally.
So why the change? Well, because that’s how we practice medicine. As allopathic physicians, we practice medicine based on scientific principles. As we advance the science of medicine, we change what we do. Now, why are we leaving money on the table when it comes to work? Why are we not taking advantage of billable hours? Your malpractice attorney does, believe me.
It’s because the tools to help us code and bill for our services have not kept up with the changes that have occurred in healthcare. We went through the list. Yet as a surgeon and a veteran, I value efficiency and clear communication. And right now, when it comes to our ability to capture these codes and bills, we have neither. And that is the problem. It is so onerous to code for that curbside that you just don’t do it. It’s just more work in an already overwhelming day.
My partner Niraj Jane and I founded Clinician Core with the goal that we would not create an app that would just be another task in your ever-expanding list. We wanted to put you into a position where the administrative part of medicine becomes invisible. That is where the healthcare collaboration or the HCC module comes in. This is part of Clinician Core.
Instead of a messy hallway chat, the platform handles the orchestration of the curbside. It’s an automatic audit trail. It tracks the consultative time for you. There is integrated reporting. It captures the discussion and helps generate the required written report for the EHR. And then there’s HIPAA security. It moves us away from that risky SMS texting and into a 100% compliant environment. We are essentially taking that curbside expertise and turning it into a formal, billable, and protected clinical event.
And that’s it. It’s as easy as that. You are now moving into the 21st century where a laparoscopic cholecystectomy is better than an open surgery and the HCC module of Clinician Core is better than the old billing and coding methods of years gone by. Think about a concept. You spent a minimum of 14 years in education and training to get to where you are. Many of you have spent years and decades in the practice of medicine. You have knowledge and expertise that no one else has and to which many of your colleagues want access. You represent tremendous intellectual wealth. Why not make that intellectual wealth put more money wealth into your practice?
Now, I’m sure you might be thinking that, well, it’s 35 bucks for the minimum amount of time for a curbside. Why bother? But my answer to that would be this. First of all, more commonly than not, that curbside lasts longer than you think, which means it will bill higher. Secondly, billable interactions add up. And finally, if you don’t bill for it, you’re leaving money on the table, money that is yours.
This week, I was not on call and I encountered five curbside consults. I’m on call this weekend and I guarantee I’ll get five more. That’s 10. At the minimum billing, that’s $350. Using Clinician Core’s HCC feature, I could probably recoup $1,000 a month in charges that I’m not capturing now. That adds up. But here’s the best part. You don’t have to do anything different than you’re already doing. You just use ClinicianCore HCC feature to connect and engage with your colleagues and you’re set to go.