5 Minutes Consult

[Enrique Fats]

Initialvs. subsequent is determined based on whether the patient has received any professional services from the physician or other QHP or another physician or other QHP of the exact same specialty and subspecialty who belongs to the same group practice during the stay. This is like the new vs. established patient definitions, except the determining factor is related to the stay rather than the past three years.

Hospital Inpatient or Observation Care Services require that the patient be admitted and discharged on the same date of service and the stay must be at least eight hours. Only the physician or QHP who performs both the initial and discharge service may report these services. When a patient receives hospital inpatient or observation care services for fewer than eight hours, use the initial hospital inpatient or observation care codes (CPT codes 99221-99223).

Most of the guidelines for the consultation codes remain the same. Code descriptors have been edited to reflect the revised MDM and time requirements. Note: Medicare does not cover consultation codes.

Time cannot be used to select the level of service for emergency department visits. The level of service is based on MDM. This does not differ from the previous guideline. However, the MDM levels have been modified to align with those for office visits.

Nursing facility discharge services require a face-to-face encounter with the patient and/or family/caregiver that may be performed on a date prior to the date the patient leaves the facility. The level of service should be selected based on the total time on the date of the face-to-face discharge management encounter.

The CPT code for annual nursing facility assessment (CPT code 99318) has been deleted. These services can be reported using the subsequent nursing facility care services (CPT codes 99307-99310) or Medicare G codes.

If you're thinking about hiring a designer, or curious about what the heck we can do for you, this consult is a great way to test the waters! If you are located in the Portland metro area, we will come to your home or office and provide you with as many valuable ideas and expert advice that we can cram into 90 minutes.

We will discuss things like the scope of your project, your budget and timeline (and how realistic those look) and share the recommended vendors and tradespeople we feel would best suit your project. We can sketch out preliminary ideas, give you direction on space planning, pull paint swatches, discuss finishes or fixtures, and so much more.

If consult exceeds 90 minutes, additional time will be charged at $200 per hour, in 15 minute increments.

Because of our limited time and involvement, clients are ultimately responsible for ensuring that all furniture and material selections work within the space.

Client is wholly responsible for all items purchased by the Client. Wise Design cannot guarantee any fabric, material, or products against wearing, fading, soiling, or any other latent defect.

We do our best to refer quality tradespeople, but ultimately cannot be responsible for the workmanship of others.

The IEP team may discuss consultation as support or training for school personnel. This is consultation that would help school staff work more effectively with your child to help her attain annual goals, to access and progress in the general curriculum, and to participate in extracurricular and other nonacademic activities.

For example, behavioral consultation with a school psychologist, social worker, or other behavioral consultant. Or, a classroom teacher who has a student with a visual impairment consults with a teacher of students with visual impairments about visual abilities of students, appropriate classroom materials, and strategies for working on scanning. This support should be written in the IEP.

When consultation as support and training is documented in the IEP, use it to monitor the service delivery. You should receive reports about what consultation services took place, and when. If not, ask for the records that show:

You can certainly request that the IEP team put that in the IEP, but it is likely they will not want to do this, especially if the OT is not present. You could proposal some sort of compromise, i.e. a certain # of sessions each semester by the OT, &/or OT observing the assistant periodically live or recorded.

You can request an IEP meeting to request that the OT only or for a specific amount of time work with your child. Request that the OT be there. Document in writing your concerns about lack of progress,& your efforts to address this situation. Be sure to record or document the discussion. If they say no, they are to give you a prior written notice of refusal. From there you may need to use the state dispute resolution process. Your state parent training & information project or disability rights project can give you further support. -your-center  

Having a streamlined consult process and a veterinary nurse to assist the clinician is key to keeping on time in a busy practice while maintaining a good service to the otitis patients who need more time and attention

Statistics show that 32 percent of canine consults are skin cases in general practice, and that 20 to 30 percent of these are otitis cases. Therefore, 6 to 10 percent of consults in small animal practice are about ears.

Otitis cases often require more frequent, regular appointments and, unless you are careful, the day will fill up with ears! This means that, with a consult room running at approximately 220 per hour, the longer the consult, the more expensive it becomes. It is important that your practice is streamlined, and doing this requires a whole practice approach. One idea would be to run otitis clinics twice a week (perhaps for two hours in the morning). It is important to remember that the veterinary nurse (VN) can assist with this greatly to keep everything flowing.

Now, the usual method during a consult if assistance is required is that the clinician calls out the back for a nurse and waits to see who appears! If this happens, the VN might be called away from something they are involved in and they are not primed for the appointment. Organisation is key for time management. So, a better way to manage these situations is for VNs to be integrated into the consult from the beginning, which will see your staff working to the best of their abilities and help your consults flow smoothly.

How does the clinician carry out a thorough examination, perform cytology and microscopy, explain their findings to the owner and make a plan, plus write up detailed notes in a 15-minute consult? The VN can provide invaluable aid in this instance.

This includes holding for otoscopic examination, stocking clean (autoclaved) otoscope heads (one for each ear) and any other consumables needed, sending off samples and filling out the lab forms, and staining and examining samples.

The benefits to having this consult format and involving your VNs in the process are that the owner is given a diagnosis in the consultation room and that they can be reassured that, with the diagnosis, a plan has been formulated. They also have a point of contact (the VN) who may be more available to them for future questions or concerns. It is worth noting that in otitis cases, it is the owner doing the cleaning and medicating at home, so getting a good rapport with them is vital from the beginning to have them on board.

It takes time to work up and treat ear disease, and to explain the required information to the care giver. Having a VN to assist the clinician is key to keeping on time during a busy surgery while offering a good service to patients that need a little extra time and attention. It gives the clinician time to focus on strategic planning for the case, provides the VN with a rewarding role within the practice and hopefully results in a satisfied client and a happier pet.

There is an unprecedented growing mental health crisis among all ages across the country. One in five adults experience a diagnosable mental health disorder and two out of five report symptoms of anxiety and depression (NAMI, June 2022). It is critical that those who struggle with mental health problems receive medically necessary care; however, less than half of those who need care are receiving the help they need. Timely access to mental and behavioral health services is often limited by resources, especially in rural and underserved, uninsured, and ethnically diverse patient populations.

Interprofessional consultation services offer several key benefits, including timely access to mental and behavioral specialty care, decreased need for in-person referral or visit, shortened wait times, and an opportunity to support providers in a team-based approach to care. Non-face-to-face consultations are a way to get patients rapid access to specialty psychology expertise that benefits both the patient and the provider.

CPT code 99451 is reported for the total time spent by the consulting psychologist to access data/information via the electronic health record (EHR), telephone, or internet, performing data review and/or analysis, and interprofessional communication. While a verbal opinion report is not a required component when reporting code 99451, the psychologist must provide a written report to the treating/requesting provider for inclusion in the patient record.

A primary care physician (PCP) consults a psychologist by telephone conversation. The PCP states that consultative services are needed for a 20-year-old Latinx female patient who presents with flat affect, weight gain, and significant fatigue. The patient reports that she has been staying up until 3 or 4 a.m. and sleeping all day. She failed two of her classes and will have to attend summer school to make up the credits. Her PHQ-9A is elevated (14) and she reports having thoughts of harming herself on item 9.

The psychologist consultant reviews the case and verbally provides the PCP with assessment and management recommendations which include the need to complete a risk assessment and safety plan prior to leaving the clinic, a plan to conduct ongoing safety checks, and referral to a community therapist. Also, recommendations on sleep hygiene, behavioral activation, and lifestyle issues related to weight management. The psychologist then writes up the assessment and management recommendations and transmits the report to the treating/requesting provider for inclusion in the patient medical record.

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