Tag Archives: consultation

Mike Farrell and The Role of The Consultant

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Jose Garza recently shared this lecture from one of our mentors, Mike Farrell. I really enjoyed being able to hear and see him. This lecture discusses the role of being a consultant and how many things have changed over the years. It is amazing that Mike has been at Cincinnati for 50 years and has instructed so many residents, clinicians as well as GI trainees. The main task is still providing assistance to our colleagues in a respectful manner. I’ve included some of his slides.

Link: The Consultation: An Ancient and Venerable Process in the Modern Age

Often, the person requesting the consult does not know exactly why they are requesting a consult.
Dr. Farrell recommended documentation with phone consultation that patient
was not examined and to please call back if needed and patient could be seen.
Dr. Farrell says he often starts a visit with a family by asking ‘How Can I Help You?’
On the left: Dr. Schubert (one of Dr. Farrell’s mentors).
On the right: Christine Heubi, Jim Heubi, Mike Farrell and Peter Farrell.

On a separate note, Mike was honored recently by Cincinnati Children’s with the Drake Medal. Link: Mike Farrell, Recipient of Drake Medal Some of the accomplishments noted in this article:

  • Among the first to study the relationship between infantile apnea and gastroesophageal reflux
  • Helped define the hepatobiliary complications associated with parenteral nutrition
  • Participated in important studies defining vitamin D, calcium and phosphorus requirements in infant parenteral nutrition solutions
  • Invented the Farrell Valve Enteral Gastric Pressure Relief System, aka the Farrell bag—a disposable plastic bag that is connected to vent a feeding tube, which is now used nationwide.
  • Presented with the 2007 Murray Davidson Award from the American Academy of Pediatrics (AAP)

Coding Correctly in 2023

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The following information was provided by our coding advisor, Mary Suhr.

Key points:

  1. Time codes (when used) for inpatient visits have changed (see below). In 2023, when you share a service with an APP, you may bill on patient medical decision making or time spent.  You can add the time together and whoever spends more total time on that date of service (including face to face and non-face to-face) gets to be the service provider for that charge. 
  2. Extra time code: 99418 for every 15 minutes increments above average inpatient code.
  3. Observation codes are obsolete.
  4. Specific requirements for documentation of History and Physical exam are NOT needed for coding. Good documentation is still important part of medical practice and for liability; patient still needs to be examined.
  5. ALL outpatient and inpatient E/M visits will be leveled using the same methodology.
  6. Coding is based on medical decision making or time code (whichever has higher complexity). When selecting a level of service for Medical Decision Making, there is still the concept of having three components/tables and the requirement that two of the three components are met.  Tables 1, 2, and 3 outline the requirements.
  7. CPT 99251 (Straightforward Inpatient Consult) and CPT 99241 (Straightforward Outpatient Consult) are going away because the history and exam requirements for consults no longer apply and history/exam was the only difference between level 1 and level 2 consultation codes.
  8. For consultations, you still need a requesting provider, a reason for the consult and a report back to the provider.  CMS was explicit this year that assuming care of the problem is not considered a consult.
  9. Consultations cannot be shared between two providers (e.g. physicians and APPs).  If a consultation is shared between an APP and a MD, our advisor recommends the use admission codes for those.  This is true for inpatient consultations as well as office-based consultations.

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