148 - Implementing Provider-to-Provider Interprofessional Consults in a Freestanding Children's Hospital

Publication Number: 3142.148

Caitlin Li, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Marcelo Malakooti, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Alexa Gilman, Ann & Robert H. Lurie Children's Hospital of Chicago, Riverwoods, IL, United States; Agata Nytko, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Erin Claussen, Ann & Robert H. Lurie Children's Hospital of Chicago, Albert Lea, MN, United States; Jill Samis, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Robert Greenberg, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Maria Dowell, Ann & Robert H. Lurie Children's. Hospital of Chicago, Chicago, IL, United States; Dana Schinasi, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Ravi Jhaveri, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Subspecialty providers frequently provide informal medical advice to guide the care of patients they have not seen. Multiple CPT codes (99446-99449, 99451) now support billing of provider-to-provider consultations without direct patient visualization. A pilot within one division previously demonstrated positive feedback by colleagues and favorable reimbursement by both commercial insurance and Medicaid of these interprofessional consults (IPCs).

Objective: We sought to implement a hospital-wide process for completing and billing for IPCs.

Design/Methods: After this work was deemed quality improvement by our institutional review board, we completed a series of plan-do-study-act cycles to spread the use of IPC billing codes at our freestanding children's hospital. These consisted of standardization of expectations within the pilot division; development of system-wide and division-specific templates; education of clinical practice directors, APP leadership, and division heads; targeted presentations to local divisions; tip sheet creation; and system-wide attestation smart texts. (Figure 1). Our outcome measure of interest was the number of IPCs performed per week. Our process measure was the number of participating specialties, and our balancing measure was the number of in-person consultations performed. Data were monitored on statistical process control charts.

Results: Following the start of interventions in March 2025, the average number of IPCs performed by participating specialties increased from a baseline average of 1.1 ultimately to 28.6 per week (Figure 1). At the time of publication, 14 specialties were performing IPCs (Cardiology, Endocrinology, Gastroenterology, Genetics, Hematology, Hospital-based medicine, Infectious Diseases, Nephrology, Neurology, Oncology, Pain team, Pediatric surgery/wound care, Pulmonology, Rheumatology). In person consultations did not decrease following implementation of IPCs.

Conclusion(s): IPCs are a viable alternative to curbside consultations that both support safer communication via improved documentation of these recommendations and allow for reimbursement of previously uncompensated work.

Figure 1: C statistical process control chart of interprofessional consult counts by week
Abbreviations: APP - Advanced Practice Provider, ID- Infectious Diseases, IPC - Interprofessional Consults, PDSA - Plan-Do-Study-Act

Figure 2: Balancing measure - in-person consult volumes
As absolute consult volumes are not publicly reportable, volumes are shown as a percent change from average pre-intervention volumes of CPT codes 99221-99223 and 99231-99236 billed by the cardiology, endocrinology, genetics, hematology, infectious diseases, nephrology, oncology, pulmonology, and rheumatology services. No special cause variation is noted after the start of our interventions in March 2025