Interprofessional Consults

Interprofessional eConsults offer a regulatory-safe, reimbursable, and efficient alternative to traditional telemedicine. Even with telehealth regulations remaining uncertain, the interprofessional econsult codes provide a stable reimbursable and effecient solution for expanding access to specialty care without the legal and financial challenges associated with patient-facing virtual visits. As healthcare systems continue to adapt to digital transformation, eConsults stand as a proven, long-term strategy for improving collaboration, reducing costs, and enhancing patient care outcomes.

Why eConsults Are a Game-Changer for Specialty Care

Regulatory-Safe & Not Classified as Telemedicine

Interprofessional eConsults are not subject to the same telemedicine regulations that frequently change, ensuring consistent reimbursement and minimal legal barriers.
Since they are provider-to-provider and do not involve direct patient interaction, they bypass restrictions on cross-state licensing and telehealth coverage limitations.

Stable, Reimbursable, and Recognized by Medicare & Insurers

The CPT codes (99446-99452) for interprofessional consultations are well-established and widely reimbursed by Medicare, Medicaid, and private insurers.
Unlike patient-facing telemedicine, which may require separate infrastructure, platform compliance, and evolving reimbursement policies, eConsults have a stable, well-defined billing structure.

Expanding Access to Specialty Care—Without Delay

Many patients wait weeks or months to see a specialist, leading to delayed diagnoses and treatment.
With an eConsult, PCPs can get expert cardiology recommendations from Dr. Brown within 48 hours, helping them manage complex cardiac cases efficiently while keeping patients under their care.

Cost-Effective for Healthcare Systems & Patients

Reduces unnecessary specialist referrals—many cases can be managed in primary care with expert cardiology input.
Decreases emergency visits and hospitalizations by providing early cardiovascular risk assessments.
Lowers overall healthcare costs by preventing avoidable in-person specialty visits and redundant testing.

Enhancing Collaboration & Patient Outcomes

Strengthens interprofessional relationships between primary care, cardiology, and other specialties.
Promotes evidence-based care by ensuring that patients receive timely, high-quality, and expert-driven cardiovascular management.

The Future of Specialty Care: Digital Collaboration Through eConsults

As healthcare systems continue to adapt to digital transformation, eConsults stand as a proven, long-term strategy for:
✔ Improving collaboration between PCPs and specialists
✔ Reducing costs while enhancing access to expert care
✔ Optimizing patient management without unnecessary referrals or delays

Interprofessional eConsults with Dr. Sherry-Ann Brown at My Heart Spark P.C. are a stable, innovative, and effective solution for modernizing cardiovascular care—empowering healthcare providers and patients alike.

My Heart Spark P.C. Cardiology Review

Comprehensive Interprofessional Cardiology Consult Program for Multiclinic Models

Heart Disease: The Leading Cause of Death in the United States

Heart disease remains the number one killer in the United States, accounting for approximately 1 in every 5 deaths.

According to the Centers for Disease Control and Prevention (CDC):

Nearly 700,000 Americans die from heart disease each year—that’s about one death every 33 seconds.
Over 805,000 Americans experience a heart attack annually, with roughly 1 in 5 being silent, meaning the damage has already occurred without noticeable symptoms.
Cardiovascular disease costs the U.S. healthcare system nearly $239 billion per year, including healthcare services, medications, and lost productivity.

Despite effective treatments and preventive measures, many patients with cardiovascular risk factors never see a cardiologist or do so only after a significant health event.

The My Heart Spark PC Cardiology Review: A Game-Changer in Cardiovascular Care

With heart disease continuing to be the leading cause of death, the My Heart Spark PC Cardiology Review bridges this critical care gap, ensuring every primary care patient receives expert cardiovascular input without delay.

By embedding Dr. Sherry-Ann Brown’s cardiology expertise into the primary care setting, this innovative program enhances early detection, risk factor management, and timely specialist intervention, potentially reducing preventable hospitalizations, strokes, and heart attacks.

Through seamless interprofessional collaboration and cutting-edge virtual cardiology services, My Heart Spark PC is revolutionizing cardiac care access, making cardiology care proactive, efficient, and patient-centered.

For every patient, at every visit, at every opportunity—because heart health matters.

Integrate expert cardiology care into your primary care experience today!

Overview of the Program

The My Heart Spark PC Cardiology Review is a specialized interprofessional cardiology consult service designed to provide expert cardiology insights directly to primary care providers (PCPs) in a multiclinic model. Led by Dr. Sherry-Ann Brown, this program ensures that every primary care patient receives expert cardiology input without the need for a separate specialist appointment.

This service leverages interprofessional electronic consults (eConsults) to facilitate seamless collaboration between Dr. Sherry-Ann Brown and primary care teams, ensuring timely, high-quality cardiovascular guidance for optimal patient outcomes.

For patients who prefer direct cardiology consultation, Dr. Brown is also available for virtual cardiology visits, providing a flexible and patient-centered approach to cardiovascular care.

How the My Heart Spark PC Cardiology Review Works

1. Interprofessional Cardiology eConsults (Provider-to-Provider)

Every primary care patient in the multiclinic system is automatically eligible for a cardiology review eConsult with Dr. Brown.
PCPs can initiate a cardiology review interprofessional eConsult request for EVERY patient, for ANY patient, at ANY time, especially when they encounter a patient with:
- Any type of cardiovascular concerns or risk factors
- Challenges with statin intolerance
- Any other cardiovascular health conditions
- Complex cardiology-related cases requiring expert input
Dr. Brown reviews the patient’s medical history, diagnostic data, and PCP’s specific questions asynchronously via a secure electronic health record (EHR) system or encrypted communication platform.
Within 48 hours, Dr. Brown provides:
- Expert recommendations on diagnosis and management.
- Guidance on next steps, including medication adjustments, lifestyle modifications, or further testing.
- A formal consultative report document in the patient’s chart for the PCP to review.

2. Optional Virtual Cardiology Visits (Direct Patient Consultation)

If a patient wishes to consult Dr. Brown directly, they can schedule a virtual cardiology appointment through My Heart Spark PC.
This visit will be a full cardiology consultation, allowing for direct assessment, treatment planning, and shared decision-making.
Patients have the flexibility to opt for a one-time virtual cardiology visit or ongoing specialist follow-up care.

Billing and Reimbursement Structure

Interprofessional eConsult CPT Codes (Provider-to-Provider)

For PCP-initiated eConsults, the following CPT codes apply:

99446: 5-10 minutes of consultative discussion and review.
99447: 11-20 minutes of consultative discussion and review.
99448: 21-30 minutes of consultative discussion and review.
99449: 31+ minutes of consultative discussion and review.
99451: 5+ minutes of assessment and management, including a written report.
99452: 30 minutes of PCP preparation for the eConsult.

Virtual Cardiology Visits (Direct-to-Patient)

Virtual visits will be billed as standard telemedicine E/M services.
Covered by Medicare, Medicaid, and many commercial insurers, subject to telehealth reimbursement policies.

Key Benefits of the My Heart Spark PC Cardiology Review

For Patients

* Expert Cardiology Input Without a Separate Visit – Patients receive specialist-backed recommendations through their trusted PCP.
* Convenient & Seamless Care – No need to book a separate cardiology appointment unless preferred.
* Early Detection & Prevention – Proactive cardiovascular risk assessment reduces complications and enhances long-term health.
* Access to a Cardiologist When Needed – Flexible options for virtual visits when patients desire direct specialist consultation.

For Primary Care Providers

* Direct Access to a Renowned Cardiologist – Dr. Brown’s expertise enhances PCP decision-making.

* Faster Specialist Input – eConsults are completed within 48 hours, eliminating long wait times for specialist referrals.
* Better Patient Outcomes – Timely cardiology guidance helps PCPs manage complex cases confidently.
* Enhanced Billing & Reimbursement – PCPs bill CPT 99452 for their role in the eConsult process.

For the Healthcare System

* Optimized Specialist Utilization – Cardiologists focus on more complex, high-priority cases, improving healthcare efficiency.
* Cost-Effective Care – Fewer unnecessary referrals lead to significant cost savings for payers and health systems.
* Scalable & Sustainable Model – The program is easily adaptable to primary care networks, ACOs, and value-based care initiatives.

How to Get Started

Steps for PCPs:

Identify Patients – Any primary care patient with cardiovascular risk factors, symptoms, or a complex case can receive a cardiology review eConsult.
Submit an eConsult Request – Use the secure EHR platform to send the case to Dr. Sherry-Ann Brown.
Receive a Specialist Report – Within 48 hours, a detailed cardiology consultation report will be available for use in patient care.
Offer Virtual Cardiology Visits – If a patient desires direct specialist care, they can book a virtual appointment with Dr. Brown.

Join the My Heart Spark PC Cardiology Review Today

✔ No extra effort for patients
✔ PCPs remain at the center of care
✔ Seamless, cost-effective, and expert-driven cardiology support

Empower your patients and enhance primary care with cutting-edge cardiology expertise.

Contact My Heart Spark PC today to learn more and integrate expert cardiology care into your primary care practice!

Step-by-Step Guide for Primary Care Providers (PCPs)

Time Breakdown (16-30 Minutes)

When submitting a cardiology review interprofessional eConsult request, primary care providers engage in multiple tasks that ensure a comprehensive and efficient consultation with Dr. Sherry-Ann Brown. Below is a detailed breakdown of what PCPs can spend 16 to 30 minutes on while preparing and submitting the request.

Step 1: Discussing the Cardiology Review Benefit with the Patient (5-10 minutes)

* Introduce the My Heart Spark PC Cardiology Review

Explain that this specialized cardiology review allows Dr. Sherry-Ann Brown to provide expert cardiology recommendations without requiring a separate specialist visit.
Emphasize that the review enhances cardiovascular care and helps with early detection, risk management, and better treatment planning.
Let the patient know that this service is available for every primary care patient and that the PCP can initiate an eConsult at any time.

* Obtain Verbal Consent

Ensure that the patient agrees to have their case reviewed through an interprofessional eConsult.
Document the patient’s verbal consent in the EHR system, noting their understanding and approval of the cardiology review process.

* Answer Patient Questions

Address any concerns or questions the patient may have about the cardiology review process.
Explain that Dr. Brown will not bill the patient separately and that the eConsult is a provider-to-provider collaboration aimed at optimizing their cardiovascular care.

Step 2: Reviewing and Gathering Patient Data (5-10 minutes)

* Identify the Medical History Relevant to the eConsult

Review the patient’s records to ensure that all pertinent cardiovascular history is included in the request.
Extract key information such as:
- Previous cardiac diagnoses (e.g., hypertension, arrhythmias, coronary artery disease).
- Lipid panel results and cholesterol management history.
- Statin intolerance documentation, if applicable.
- Any prior cardiology visits or cardiac test results.
- Family history of cardiovascular disease.

* Identify and Attach Relevant Medical Records

Gather supporting documents, such as:
- Recent lab results (lipid panel, troponin, BNP, glucose, kidney function, hemoglobin A1C, etc.).
- ECG or EKG results.
- Echocardiogram reports.
- Stress test or coronary artery calcium score reports.
- Blood pressure logs or home monitoring data.

* List Current Medications & Treatment History

Summarize the current medications the patient is taking, particularly:
- Antihypertensives (e.g., ACE inhibitors, beta-blockers, calcium channel blockers).
- Lipid-lowering therapies (e.g., statins, PCSK9 inhibitors, ezetimibe).
- Antiplatelet or anticoagulant therapies (if applicable).
- Diabetes medications that impact cardiovascular risk (e.g., SGLT2 inhibitors, GLP-1 receptor agonists).

Step 3: Writing or Dictating a Summary Letter (Optional, 3-7 minutes)

* Compose a Brief Narrative About the Patient

PCPs may choose to dictate a letter or write a concise summary that provides context for Dr. Brown.
The letter may include:
- A summary of the patient’s cardiovascular risk factors.
- An explanation of why cardiology input is needed.
- Any specific questions or concerns the PCP wants Dr. Brown to address.

* Example Summary Letter:

Dear Dr. Brown,

I am submitting an interprofessional eConsult for our mutual patient, [Patient Name], a [Age]-year-old [Male/Female] with a history of [hypertension, hyperlipidemia, type 2 diabetes, etc.]. The patient has been experiencing [symptoms such as chest discomfort, shortness of breath, exertional fatigue, etc.] and has struggled with [statin intolerance or difficulty managing blood pressure].

I am seeking your expertise on [specific question, such as statin alternatives, need for advanced cardiac imaging, medication adjustments, or cardiovascular risk assessment]. The patient has had a [recent ECG, echocardiogram, or stress test], and the results are attached for your review.

Thank you for your guidance in optimizing this patient’s cardiovascular care.

Step 4: Entering and Submitting the eConsult Request in the System (3-7 minutes)

* Navigate to the EHR eConsult Portal

Log into the electronic health record (EHR) system and locate the interprofessional eConsult request section.

* Fill Out the eConsult Request Form

Enter the patient’s demographics, including name, age, and medical record number (MRN).
Specify the reason for the cardiology review (e.g., cardiovascular risk assessment, statin intolerance, abnormal ECG, suspected heart failure).
Attach relevant medical records, lab results, and dictated notes.
Indicate the urgency level and confirm that the request is routed to Dr. Sherry-Ann Brown.

* Review and Submit the Request

Double-check the information for accuracy and completeness.
Submit the request and document it in the patient’s chart.
Notify clinic staff or the patient (if needed) about the estimated turnaround time (48 hours for Dr. Brown’s expert review).

Final Step: Documenting and Billing for the PCP’s eConsult Preparation Time (1-3 minutes)

* Capture Time Spent in Documentation

Ensure that the PCP’s preparation time (16-30 minutes) is documented in the system.

* Bill Using CPT Code 99452

PCPs can bill CPT 99452 for their role in preparing and submitting the eConsult request.

Summary of Tasks and Time Allocation (Total: 16-30 Minutes)

Discussing the cardiology review with the patient and obtaining consent: 5-10 minutes

Reviewing the patient’s medical history and gathering relevant records: 5-10 minutes

Writing or dictating a summary letter: 3-7 minutes

Entering and submitting the eConsult request: 3-7 minutes

Finalizing documentation and billing for time spent: 1-3 minutes

Conclusion

By spending 16 to 30 minutes on the My Heart Spark PC Cardiology Review eConsult request, primary care providers ensure that every patient receives expert cardiology input seamlessly. This process:

* Maximizes efficiency and collaboration between PCPs and cardiology specialists.

* Allows for a thorough review of the patient’s cardiovascular history and risk factors.

* Enhances patient care by reducing the need for unnecessary specialist visits.

* Enables appropriate billing and reimbursement for the PCP’s time spent on case preparation.

By integrating this structured approach, PCPs can confidently leverage Dr. Brown’s expertise, improving patient outcomes while maintaining a streamlined and reimbursable workflow.

Download Document with Interprofessional eConsults Worksheet Links

Overcoming Challenges in Telemedicine Regulations

The telemedicine regulatory landscape is complex and ever-evolving, with challenges stemming from federal and state regulations, reimbursement policies, licensure requirements, and privacy laws. Several factors contribute to the uncertainty surrounding the future of telemedicine:

1. Variability in State Regulations

Each state has different rules governing telemedicine practice. Some states have adopted policies that promote telehealth expansion, while others impose strict limitations on virtual care delivery, requiring in-person visits before prescribing medications or placing restrictions on cross-state telehealth services.

2. Licensure Barriers and Interstate Practice Limitations

Many telehealth providers struggle with licensing issues, as they must be licensed in the state where the patient resides. The Interstate Medical Licensure Compact (IMLC) has made cross-state licensing easier in some areas, but not all states participate, limiting providers' ability to offer telemedicine services across state lines.

3. Uncertainty in Medicare and Medicaid Coverage

During the COVID-19 pandemic, telemedicine regulations were temporarily relaxed to expand access to virtual care. However, many of these waivers are set to expire, leading to uncertainty regarding future Medicare and Medicaid coverage for telehealth services. Policies such as originating site restrictions, audio-only service limitations, and the requirement for established provider-patient relationships may impact reimbursement.

4. Private Insurance Variability

Commercial insurers have inconsistent policies regarding telemedicine coverage. Some insurers fully reimburse virtual visits at the same rate as in-person visits, while others apply lower reimbursement rates or impose restrictions based on the type of telehealth services provided.

5. Privacy and Security Concerns

HIPAA regulations require secure communication platforms for telehealth, which can be a challenge for providers relying on third-party services. The temporary relaxation of HIPAA enforcement during the public health emergency (PHE) allowed the use of non-secure platforms, but once these exceptions end, telehealth providers must ensure compliance with stringent security measures.

6. Future of Telehealth Post-Pandemic

The long-term viability of telemedicine hinges on whether temporary regulatory changes will be made permanent. Many healthcare organizations are waiting for definitive federal guidance, particularly from the Centers for Medicare & Medicaid Services (CMS) and the Drug Enforcement Administration (DEA), regarding policies on virtual care reimbursement and controlled substance prescribing.

How Interprofessional eConsult Codes Provide a Solution

In contrast to traditional telemedicine services, interprofessional electronic consults (eConsults) provide a unique solution that avoids many of the regulatory and reimbursement uncertainties facing telehealth. These consultations involve provider-to-provider communication, where a primary care physician (PCP) or other treating provider seeks the expertise of a specialist through asynchronous or synchronous electronic means.

The CPT codes for interprofessional eConsults (99446-99452) allow for reimbursement without being classified as telemedicine, thereby circumventing many of the challenges faced by direct-to-patient telehealth encounters.

1. Exempt from Telemedicine Regulations

Unlike traditional telemedicine, eConsults do not involve direct patient-provider video visits and therefore do not fall under the same telehealth-specific regulations. Because they are strictly provider-to-provider communications, they avoid:

State Licensure Barriers: eConsults allow specialists to provide recommendations to a treating provider without requiring a state license in the patient’s jurisdiction, as long as the treating provider remains the primary provider of care.
Telehealth Restrictions: Many telemedicine policies require an initial in-person visit before virtual consultations can occur. eConsults do not have this requirement, making it easier for providers to obtain specialty input without unnecessary delays.

2. Consistent Reimbursement Structure

Interprofessional eConsult codes are recognized by Medicare, Medicaid, and many commercial payers, offering a stable reimbursement framework that is not subject to the uncertainties affecting telemedicine. Key advantages include:

Time-Based Compensation: The codes are billed based on the time spent reviewing patient records and communicating between providers, ensuring appropriate reimbursement for the specialist’s expertise.
No Originating Site Restrictions: Unlike telemedicine visits that may require patients to be seen at an eligible healthcare facility, eConsults are not location-dependent and can be performed regardless of where the patient is located.
No Direct Patient Interaction Required: Since eConsults focus on provider communication rather than direct patient interaction, they do not require the additional documentation burdens associated with telemedicine visits.

3. Enhancing Access to Specialty Care

Specialist shortages and long wait times for in-person referrals create significant barriers to care. eConsults provide:

Faster Specialist Input: Instead of waiting weeks or months for an in-person specialist appointment, primary care providers can get expert advice within days or even hours via eConsults.
Improved Patient Outcomes: Many conditions can be managed effectively in primary care with specialist guidance, reducing unnecessary referrals and increasing patient satisfaction.

4. Lower Costs and Increased Efficiency

Healthcare systems and payers favor eConsults because they reduce overall costs by:

Preventing unnecessary in-person specialist visits and diagnostic tests.
Decreasing emergency department (ED) visits by ensuring timely specialist guidance.
Optimizing care coordination between primary care and specialty providers.

5. Compliance with Documentation and Privacy Standards

Unlike telemedicine, which has variable privacy requirements across states and payers, eConsults are already compliant with existing documentation and billing requirements:

HIPAA-Compliant Communication: Since eConsults occur within secure electronic health record (EHR) systems or other encrypted communication platforms, they meet privacy regulations without the need for additional telehealth security measures.
Clear Documentation Pathways: The consultant must provide a written report to the requesting provider, ensuring appropriate medical record documentation for reimbursement and legal purposes.

The Stability of eConsult Codes in an Uncertain Telehealth Landscape

The major advantage of interprofessional eConsult CPT codes is their stability compared to telemedicine reimbursement policies. While the future of traditional telehealth remains uncertain due to pending regulatory decisions, eConsult codes are well-established, consistently reimbursed, and free from many of the legal and operational hurdles faced by virtual patient visits.

Why eConsult Codes Provide Certainty

Not Defined as Telemedicine: eConsults do not involve direct patient interaction via video or audio, meaning they are exempt from most telemedicine laws and restrictions.
Reliable Reimbursement: Unlike telehealth, which has faced fluctuating payment structures, eConsult CPT codes have been consistently reimbursed by Medicare and many commercial payers.
Exempt from Licensure Restrictions: Specialists can provide guidance across state lines without needing separate licenses in the patient’s jurisdiction.
No Face-to-Face Requirements: Telemedicine regulations often mandate an initial in-person visit before virtual care can continue, whereas eConsults are purely provider-to-provider, eliminating this requirement.
No Geographic Limitations: While telehealth services are often restricted based on patient location, eConsults can be conducted regardless of where the patient is seen.

Conclusion

Interprofessional eConsults offer a regulatory-safe, reimbursable, and efficient alternative to traditional telemedicine. With telehealth regulations remaining uncertain, these codes provide a stable solution for expanding access to specialty care without the legal and financial challenges associated with patient-facing virtual visits. As healthcare systems continue to adapt to digital transformation, eConsults stand as a proven, long-term strategy for improving collaboration, reducing costs, and enhancing patient care outcomes.

Interprofessional electronic consultations (eConsults)

Interprofessional electronic consultations (eConsults) are non-face-to-face communications between healthcare providers, enabling the treating physician or qualified healthcare professional (QHP) to seek the expertise of a specialist regarding a patient's diagnosis or management without the need for the patient to be present. These consultations enhance collaborative care, improve patient outcomes, and can reduce unnecessary specialist visits.

CPT Codes for Interprofessional eConsults:

The Current Procedural Terminology (CPT) codes designated for interprofessional eConsults are as follows:

99446: 5-10 minutes of medical consultative discussion and review.
99447: 11-20 minutes of medical consultative discussion and review.
99448: 21-30 minutes of medical consultative discussion and review.
99449: 31 minutes or more of medical consultative discussion and review.
99451: Interprofessional telephone/Internet/electronic health assessment and management service provided by a consultative physician or other QHP, including a written report to the patient's treating/requesting physician or other QHP, 5 minutes or more.
99452: Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other QHP, 30 minutes.

Reimbursement Structure:

Reimbursement for these codes varies based on the time spent and the specific code used. Approximate Medicare reimbursement rates are:

99446: $18
99447: $37
99448: $56
99449: $74
99451: $38
99452: $38

Note: These rates are approximate and can vary based on geographic location and updates to the Medicare Physician Fee Schedule.

Guidelines for Use:

Consultant (Specialist) Codes (99446-99449, 99451):
- Report these codes when a treating physician/QHP requests an opinion or treatment advice from a consultant with specific specialty expertise.
- The patient should not have had a face-to-face encounter with the consultant within the previous 14 days.
- If the consultation leads to a transfer of care or a face-to-face service within the next 14 days, these codes should not be reported.
- More than 50% of the service time must be devoted to medical consultative verbal or internet discussion.
- A verbal and written report to the treating/requesting physician or QHP is required.
- Do not report these codes more than once within a seven-day interval for the same patient.

Treating/Requesting Physician/QHP Code (99452):
- Report this code when the treating/requesting physician or QHP spends 16-30 minutes in a service day preparing for the referral and/or communicating with the consultant.
- This code should not be reported more than once in a 14-day period.
- If the time exceeds 30 minutes beyond the typical time of the appropriate Evaluation and Management (E/M) service performed, prolonged service codes may be reported.

Documentation Requirements:

The request for consultation and the reason for the request must be documented in the patient's medical record.
Verbal consent from the patient or their guardian for the interprofessional consultation must be obtained and documented, ensuring the patient is aware of any applicable cost-sharing.

When to Use These Codes:

These codes are appropriate when:

The treating physician/QHP requires the expertise of a consultant to assist in the diagnosis and/or management of a patient's problem without the need for the patient to have face-to-face contact with the consultant.
The patient has a new problem or an exacerbation of an existing problem that necessitates specialist input.
The consultation does not result in a transfer of care or a face-to-face service with the consultant within the next 14 days.

Proper utilization of these codes facilitates effective interprofessional collaboration, enhances patient care, and ensures appropriate reimbursement for the services provided.

My Heart Spark P.C.