99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient's treating/requesting physician or other qualified health care professional, 5

Name of the Procedure:

Interprofessional Telephone/Internet/Electronic Health Record Assessment and Management Service by a Consultative Physician

Summary

This procedure involves a consultative physician providing an assessment and management service for a patient using phone, internet, or electronic health records. The consultative physician reviews the patient's condition and treatment plans, then sends a detailed report to the patient's primary or requesting healthcare provider.

Purpose

This service addresses complex medical conditions that require expert consultation. The goals are to enhance patient care by providing specialized insight and to create a coordinated treatment plan between healthcare providers.

Indications

• Complex medical conditions needing specialist input
• Unresolved medical issues despite standard treatments
• Need for a second opinion
• Chronic disease management requiring multi-disciplinary coordination

Preparation

No specific preparation from the patient is generally required. The treating/requesting physician may need to provide relevant medical records, history, and current treatment plans to the consultative physician.

Procedure Description

1. The treating/requesting physician connects with a consultative physician via telephone, internet, or electronic health record system.
2. The consultative physician reviews the patient's medical records, history, and current treatment protocols.
3. A detailed written report with recommendations is prepared by the consultative physician.
4. The report is sent to the treating/requesting physician for continued patient care.

Duration

Typically ranges from 20-30 minutes depending on the complexity of the case and amount of information reviewed.

Setting

This procedure is performed remotely, leveraging digital communication tools from the consultative physician's office or healthcare facility.

Personnel

• Consultative physician
• Administrative or technical support staff to facilitate the communication if necessary

Risks and Complications

• Minimal risk as it is a non-invasive procedure
• Potential for miscommunication or misinterpretation of data
• Dependence on the accuracy and completeness of the medical records reviewed

Benefits

• Expert medical opinion and recommendations
• Enhanced care through coordinated efforts between the primary physician and specialist
• Timely interventions and treatment adjustments

Recovery

There is no recovery phase as this is a non-invasive consultation. Follow-up appointments with the primary or requesting physician may be scheduled based on the recommendations.

Alternatives

1. In-person consultation with the specialist
   • Pros: Direct examination and more immediate feedback
   • Cons: Travel required, longer wait times
2. Multidisciplinary team meetings
   • Pros: Simultaneous input from various specialists
   • Cons: Scheduling difficulties, more costly

Patient Experience

Patients may not directly interact with the consultative physician but will benefit from the coordinated approach to their care. Any discomfort or concerns can be addressed with their primary treating physician afterwards.