September 18, 2022

eConsults may benefit your practice

eConsults can have many benefits for health care professionals, their practices and their patients. We’re working with the Association of American Medical Colleges (AAMC), the nation’s leading eConsult expert, to provide you with resources for eConsult implementation.

How eConsults work

eConsults help facilitate coordination and communication between health care professionals. In place of low-complexity in-person visits, eConsults have structured templates within the electronic health record (EHR) that enable primary care providers (PCPs) to ask for and receive guidance from specialists.

The PCP will typically initiate the eConsult to ask a narrow, patient-specific question. The specialist typically responds to the question with actionable, detailed guidance to help ensure the patient receives quality care from the PCP.

eConsults have been shown to help:

  • Increase measures of patient and health care professional experience satisfaction¹
  • Promote communication between PCPs and specialists as they work from the same set of expectations before and after each referral¹
  • Improve patient access to specialty care services²
  • Enhance clinical workflows²
  • Increase care quality and efficiency²
  • Lower total costs of care³
  • Decrease the number of unnecessary tests and visits⁴

CPT codes

We reimburse for the following eConsult–specific CPT® codes for all UnitedHealthcare plans:

 

CPT code Reported by Description Concluded with
99451 Consultant Review pertinent medical records, lab/imaging studies, medication profile, etc. and medical consultative verbal or online discussion Written report to treating/requesting health care professional
99452 Treating/requesting health care professional Preparing for the consult and/or communicating with the consultant; documented annual patient consent is required to perform this Treating/requesting provider action on the received information

Keys to successful eConsult implementation

The steps typically include:

  1. Researching if your specialist network has or wants to develop an eConsults program
  2. Determining which platform your practice will use for eConsults
    • Typically, eConsults use a shared EHR or a standalone, third-party platform
  3. Developing resources to implement and sustain your eConsult program
    • This may include involvement from IT, program managers and service-line leadership

Resources

For more information about eConsults, visit these pages on aamc.org:

Questions?

If you have questions about eConsult reimbursement, please contact Provider Services at 877-842-3210.

References

1Comparing Patients’ Experiences with Electronic and Traditional Consultation: Results from a Multisite Survey. Springer Nature. Journal of General Internal Medicine. https://link.springer.com/article/10.1007/s11606-020-05703-7
2Project CORE: Coordinating Optimal Referral Experiences. Association of American Medical Colleges. https://www.aamc.org/what-we-do/mission-areas/health-care/project-core
3Anderson D, Villagra VG, Coman E, Ahmed T, Porto A, Jepeal N, Maci G, Teevan B. Reduced Cost Of Specialty Care Using Electronic Consultations For Medicaid Patients. Health Aff (Millwood). 2018 Dec; 37(12):2031-2036. doi: 10.1377/hlthaff.2018.05124. PMID: 30633678.sf
4Erin Keely, Clare Liddy, and Amir Afkham. Telemedicine and e-Health. Oct 2013. 733-738. http://doi.org/10.1089/tmj.2013.0007
CPT® is a registered trademark of the American Medical Association.
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