Wiki 2021 E/M Data Reviewed & Analyzed

[rthomas@impcna.com]

There is some confusion regarding the amount & complexity of date reviewed & analyzed. The question I have is in regards to category 1, if a provider orders 2 tests, an EKG and Spirometry for example, does this count as meeting the requirement for limited data or does the provider have to order tests and complete one of the other 2 items for it to count as limited?

 

[csperoni]

For data, Category 1, if you order 2 unique tests that you are not billing for, that counts as limited data (level 3).
For limited, must meet 1 of 2 categories, and category 1 states "ANY combination of 2"

Limited (Must meet the requirements of at least 1 of the 2 categories)
Category 1: Tests and documents. Any combination of 2 from the following:
•Review of prior external note(s) from each unique source*;
•review of the result(s) of each unique test*;
•ordering of each unique test*
or
Category 2: Assessment requiring an independent historian(s)(For the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high


Alternately, for extensive - extensive states must meet 2 of 3 categories, so no matter how many tests you order or review, unless you are also doing an independent interpretation or discussing interpretation with external HCP, you cannot meet extensive data.

Extensive (Must meet the requirements of at least 2 out of 3 categories)
Category 1: Tests, documents, or independent historian(s). Any combination of 3 from the following:
•Review of prior external note(s) from each unique source*;
•Review of the result(s) of each unique test*;
•Ordering of each unique test*;
•Assessment requiring an independent historian(s)
or
Category 2: Independent interpretation of tests
•Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported);
or
Category 3: Discussion of management or test interpretation
•Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)