From the ACEP 2026 Scientific Assembly: The Consults Already Happening—but Nobody Is Documenting Them

Part of the “From the ACEP 2026 Scientific Assembly” FabrixMed Insights series.

ED teams already ask specialists for advice every day: a hallway curbside, a phone call, a message, or a quick review of a case. The opportunity is not to declare every interaction billable. It is to identify which consultations can be structured, documented, and evaluated against payer and coding requirements.

What are interprofessional consultation codes designed to capture?

Medicare recognizes a family of interprofessional consultation codes for situations where a treating clinician requests a specialist’s opinion or treatment advice without a face-to-face visit with the specialist. The family includes consultant codes 99446–99449 and 99451, along with requesting-clinician code 99452.

The purpose is straightforward: some clinical questions can be resolved through clinician-to-clinician communication without scheduling a separate specialist visit. The code is not a reward for sending a message. It represents a defined service with documentation, consent, time, and eligibility requirements.

Why do informal consults disappear?

Informal advice often happens outside a repeatable workflow. The question may be incomplete, the relevant records may be scattered, the specialist’s recommendation may remain verbal, and the time spent may never reach the medical record or revenue-cycle team.

That creates two problems. The clinical team has less reliable memory of what was asked and recommended. The organization also cannot determine how many interactions were potentially eligible, ineligible, or simply too poorly documented to evaluate.

A prospective infectious-disease study at Fletcher Allen found that curbside consultations represented a meaningful share of specialist work. The original paper reported 17% of the unit’s clinical work value; the often-cited 21% figure requires careful explanation of its denominator. The point is not that every curbside should be billed. The point is that informal specialist work is operationally real even when it is invisible in the formal consult count. Fletcher Allen study

What did Lurie Children’s change?

Lurie Children’s formalized curbside consultations with templates, education, coaching, and an attestation workflow. Documented consultations increased from fewer than one per week to more than 40 per week, with 22% originating in the ED, while face-to-face consultation volume did not decline. That is evidence that formalizing informal input can increase visibility without eliminating higher-acuity in-person care. It is not proof that every hospital will produce the same volume or reimbursement. Lurie Children’s report

What are the eligibility tripwires?

An organization should involve its coding, compliance, clinical, and revenue-cycle teams before treating these codes as a business case. Requirements and payer policies matter. Common tripwires include:

• documented patient or family consent where required;
• a defined request and reason for the consultation;
• the specialist’s appropriate report and time documentation;
• the correct distinction between consultant and requesting-clinician work;
• frequency limits and payer-specific rules; and
• the rule that a consultation may not qualify when it results in a transfer of care or face-to-face service within the applicable period.

For EDs, the last point is especially important. Many specialty questions lead to admission, transfer, or in-person evaluation. Those cases may be clinically appropriate but not eligible for an interprofessional consultation code.

How can ConsultBridge help without overpromising?

ConsultBridge can provide a structured workflow for the request, reason, clinical context, specialist review, recommendation, and documented next action. That gives the clinical and revenue-cycle teams a better record to evaluate.

The platform does not make an ineligible consultation billable. It does not guarantee payment. It does not replace a qualified coder, payer review, consent policy, or compliance program.

What it can do is turn an informal exchange into a visible operating event. The organization can measure completed consults, response time, documentation completeness, escalation, payer acceptance, denials, and the cases that appropriately became face-to-face care or transfer.

What should leaders measure first?

Before estimating revenue, measure the workflow:

1. How many specialist questions are currently handled informally?
2. Which specialty lanes generate the most repeatable consult questions?
3. What percentage have a documented request, reason, consent, response, and time record?
4. How many convert to admission, transfer, or face-to-face evaluation?
5. Which payer and coding rules determine eligibility at each site?

The resulting number may be smaller than the total number of curbsides. That is a feature of honest analysis, not a failure of the model.

The takeaway

The opportunity is not to bill every curbside. It is to stop losing visibility into specialist work that the care team is already performing.

FabrixMed provides the workflow fabric for defining the question, routing it to the right specialist, documenting the response, and giving clinical and revenue-cycle leaders the evidence they need to decide what qualifies.