The practice scenario described in this episode is illustrative. The practice, physicians, patient details, and financial outcomes are fictional constructs developed for educational purposes. CPT reimbursement figures are based on published 2025–2026 Medicare Physician Fee Schedule rates. Individual practice results will vary.
Introduction
Welcome back to the connected practice. I’m your host, Dr. Kevin Halow, co-founder and Chief Medical Officer of Clinician Core. On today’s broadcast we’re going to address a topic that I think every clinician who does consultations has experienced. I want to talk to you about the conversation that disappears.
The Disappearing Conversation
You know the one, a colleague calls or stops you in the hallway. It could be a family practitioner, internist, hospitalist or another specialist. They need your expertise to help manage and treat that patient. You talk to your colleague for 10, 15, maybe 20 minutes. Maybe you review some imaging or labs. You think through the clinical picture with them. You give your recommendations. Call or the conversation ends. Then, you move on. Yet this was not an isolated incident; it happened daily, sometimes even days when you are not on call or days when you’re not even working.
The Value of Clinical Expertise
Let’s take a moment and break this down. That conversation was real clinical work. It required your training, your judgment, your time. Think about what it is to be a professional and to be paid for your expertise. If you’re a pilot, a consultant, an attorney, a scientist or an engineer, there is never a question of the value of your expertise and you are reimbursed for that value. However, in medicine, we have fallen into this habit of treating consultations as a professional courtesy. It’s something we do because the system runs on collegial trust. Now, that trust is real and it matters that we work together with our colleagues in order to advance patient care. I’m not suggesting we change the culture of physician consultation. What I am proposing is that we stop giving our services away for free. It’s time that we change what happens to the documentation after the consult.
A Real-World Example
Let me give you a real world example to illustrate my point. Let’s take a look at a 12 physician surgical group. These are a busy, independent, group of surgeons in private practice. They’re solid physicians in the community, they provide excellent patient care and they have a superb reputation. Recently they did a survey of their physician members. They noted that as a group, they’re conducting approximately 18 inter-professional consultations per day across the group. Some are 5 minutes, some are 35 minutes. Most fall somewhere in the middle. At the end of the year, how much of that consultation work appears on a billing statement? How much? Zero. That’s right, zero.
The Missing Infrastructure
This is not because the consultations were not billable, they were. CPT codes 99446 through 99452 exist specifically for non face to face interprofessional consultations. Phone, internet, written. The consulting specialist can bill them when a written report goes back to the requesting provider. No patient visit required. The codes have been active and payable since 2019. In this scenario, this surgical practice simply never built a workflow to capture them. Believe it or not, it is that simple. 18 consultations per day, every working day, for years, generating nothing beyond the clinical outcome they were always intended to produce. When someone in the group finally ran the math, the amount of missed revenue was close to 180,000 a year. And that’s a conservative estimate based upon Medicare rates, the actual number with commercial payers was likely higher. 180,000 per year is a lot of money to leave on the table, not in your pocket.
The conversation? So where is the disconnect? These are excellent physicians who were not doing anything wrong. They were doing exactly what we are trained to do. They answered the call, applied their knowledge, gave their recommendation, then moved to the next patient. The problem was not the behavior. The problem was the infrastructure. There was nothing in their day that flagged the consultation as a billable event. There was no prompt, no record, and certainly no moment where that system said, “Hey, this happened, document it, then route out the report and bill for the service.”
The Need for Documentation
As surgeons, we know that an unnecessary delay in the operating room has a downstream consequence. The same logic applies here. Just translate it to documentation. Every undocumented consult is a completed clinical event with no communication record, no billing record and no interaction. Oftentimes, there’s no clinical record that the consultation ever even occurred. Remember, if you did not document it, then it did not happen.
The Solution
So how did we fix this problem for our surgical group? As it turns out, the fix in this scenario was not a behavioral change for the physicians. It was a documentation trigger built into the consultation workflow itself. It was something that captured the event, auto-selected the appropriate code based on time lapsed, prompted a specific structured clinical summary, and generated the written report before the physician moved on. Think about what that means. The average time added to the consult for this documentation occur? 90 seconds. Revenue recovered in the first year? $180,000. Physician adoption by week 6? 94%. And that last number is the one that tells you everything. Physicians adopted it because it did not add burden, it removed the invisible friction between doing the work and getting credit for the work. It allowed the surgeons to be physicians and not scribes or bookkeepers. They stayed in their lane, they did their job, and the system did its job. The surgeons were no longer fighting the infrastructure. The infrastructure was fighting for them.
Call to Action & Conclusion
If you’re in a specialty with high consultation volume, I would encourage you to do one thing after listening to this episode. Pull your consultation log from last month, count the number of interprofessional calls, then ask your billing team how many of them appear on a statement. The gap between those two numbers is worth knowing. In our professional lives, conversations should not disappear unless we make them. At Clinician Core, everything auto-deletes after 30 days to maintain privacy and security, but not before you get the credit that you deserve for each and every one of the conversations that you have with your colleagues. Now, that is a conversation worth having.
This has been the connected practice, part of our series of podcasts from Clinician Core. If you enjoyed this podcast please visit our website cliniciancore.com and sign up for the waitlist to take part in our upcoming release. You can also follow us on LinkedIn, YouTube, Spotify, Instagram, Facebook, and Reddit. I am Dr. Kevin Halow, co-founder and Chief Medical Officer of Clinician Core. Thanks for listening.