Wiki 2021 E/M - tests

Create Wiki
K

KoBee

Expert
Messages
396
Best answers
0
I was wondering if by any chance if anyone can help me understand what is the difference in the guidelines between the following:


“review of the result(s) of each unique test”

And

“ Independent interpretation of test”


I find myself having a bit of trouble knowing the difference to be able to count them differently.
 
An independent interpretation would need to look similar to, say, a radiology report. The provider can't just say they looked at the images and agree with the radiologist's interpretation, they would need to provider their own, independent interpretation of the images. I see this documented when a patient is sent for imaging and comes directly back to the provider and the images haven't been interpreted yet. I've also seen this documented when the provider disagrees with the radiologist's interpretation. Hope this helps.
 
Per the AMA guide https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf :
Independent Interpretation: The interpretation of a test for which there is a CPT code and an interpretation or report is customary. This does not apply when the physician or other qualified health care professional is reporting the service or has previously reported the service for the patient. A form of interpretation should be documented, but need not conform to the usual standards of a complete report for the test.

I interpret that as you would need to view the images, but a full formal report is not required. For example, maybe the physician looks at a couple of slices from a CT focusing on only a liver mass. Your physician would not have to read the entire CT, but if it just said "reviewed images and agree", that's too flimsy.
 
Can a provider receive independent interpretation credit at a follow up visit if the test was interpreted by another provider in the same group? (ex. cardiology, one provider orders test (ekg,echo, nuclear test) but another provider does the interpretation. Can the ordering provider receive credit for independent interpretation at follow up visit?
 
A provider of the same specialty in the same group is basically considered the same physician. You cannot get credit for 2 cardiologists in the same group to do the same work.
 
Thank you everyone for your help, makes perfect send, its a learning process for all of us. I did get this to help as well, thought I would share for anyone out there who needs examples.

The difference is:



  • Review of each unique test is the provider reviewing the results that cam back from the lab or radiology division advising as to their findings:
    Example: Reviewed lab results and noted an increase in A1C to 8.6. CBC panel was normal

  • Interpretation of a test requires a specific report meeting the requirements for independent interpretation.
  • Example would be a provide getting a copy of an xray and doing their own full radiology interpretation of the xray. This would require a separate report with all the requirements. This would be rare in most offices.

 
Question regarding sub-specialty provider!!! Can a specialist (Cardiology) receive credit for reviewing a test that was ordered or interpreted by a sub-specialist (Cardiothoracic surgeon) and vice versa? These providers are billed under same TAX ID but different place of service. Any feedback is appreciated.
 
You must log in or register to reply here.
Top