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jkyles

jkyles

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Thank you!!
I just want to make sure I am reading this right. You can count the ordering of a test AND the independent interpretation of test, BUT this is not the same as ordering and reviewing the same test?

You still cannot count the order AND review of the same test, correct?
 
lgardner said:
Thank you!!
I just want to make sure I am reading this right. You can count the ordering of a test AND the independent interpretation of test, BUT this is not the same as ordering and reviewing the same test?

You still cannot count the order AND review of the same test, correct?
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Yes. I am reading this new guidance to say:
IF you are looking at the actual images and documenting your findings of a test, you may count the INDEPENDENT INTERPRETATION, even if you were the clinician that ordered the test.

I am not seeing any change to count the order and then review (of the report/result) is included. If order was not done during an E&M, you may count the review.
 
csperoni said:
Yes. I am reading this new guidance to say:
IF you are looking at the actual images and documenting your findings of a test, you may count the INDEPENDENT INTERPRETATION, even if you were the clinician that ordered the test.

I am not seeing any change to count the order and then review (of the report/result) is included. If order was not done during an E&M, you may count the review.
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Thanks Christine!

That is how I read this, too.
 
What Christine said. I assume the CPT editorial panel wants providers to get credit for the additional work of performing an independent interpretation (which includes some sort of write up).
 
tmcknight86 said:
Can a provider count the order and review on overnight tests run in office (overnight throat cultures) separately?
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No. The update only applies to independent interpretation of tests, not review of results.

The only way a practice can count a test performed in-house toward MDM is if it is a results-only test and you'd only count the order or the review, not both.
 
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csperoni said:
Yes. I am reading this new guidance to say:
IF you are looking at the actual images and documenting your findings of a test, you may count the INDEPENDENT INTERPRETATION, even if you were the clinician that ordered the test.

I am not seeing any change to count the order and then review (of the report/result) is included. If order was not done during an E&M, you may count the review.
Click to expand...
I am interpreting these guidelines the same as well! Does it matter if the test was ordered on the same date of service that the provider is documenting the interpretation?
 
My understanding is that if you order the test, it's done in house and the doctor who ordered it interprets it, that does not count towards the Data element because your office is being paid to do that test with its own CPT code. An Independent Interpretation, as I understand it is as follows. Example: Doctor orders an MRI and the report comes back from the radiologist. That counts towards the data element of MDM. If the doctor who ordered the test then finds something in the MRI that wasn't noted by the radiologist and documents their own interpretation of the test, that's an Independent Interpretation because it's done in addition to the report from the doctor who did the initial report of the test results.
 
Yes, I would agree with @Cheezum51 that independent interpretation does not apply to a test when your practice is performing the professional component.
However, there are situations where a physician may order an xray or sono, the practice performs the technical component, and the professional component is performed by an external physician (like a radiologist). If the ordering physician does a wet read, then for that day's E&M, I would count both the order and the independent interpretation.
In fact, this could be a fairly common practice in the ER.
From the 2023 errata:
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 who reports the E/M service is reporting or has previously reported the test. A form of interpretation should be documented but need not conform to the usual standards of a complete report for the test. A test that is ordered and independently interpreted may count both as a test ordered and interpreted.
I would see no reason why you could not count both the order and independent interpretation just because they were on the same date of service.
 
While we're discussing orders and interpretation counting towards the data component of MDM, let me ask this. In the past, you ordered some tests which your office was paid to do and you did the initial Interpretation and report. Since I'm an eye guy, let's say a visual fields test. The question is this: when the patient comes back for future visits and you look at these prior test results, for test you'd been paid to do, do you get credit at those future times for the data component for doing that?

Tom Cheezum, OD, CPC, COPC
 
Regarding the data component - our pediatrics office uses the CLIA wavier and runs labs such as Covid PCR/antigens, Flu, Strep, etc. After reading more into the requirements for the data component, I'm not 100% confident in what is allowed. Since our doctors order these, the nurse swabs and runs the test in house, and the doctor reads the results, this still can not be used as a data component requirement. Is that correct? Or since we use the QW, does that change anything and allow us to include this, or does the data only include things like Xray, bloodwork labs, u/s, etc?
 
Cheezum51 said:
While we're discussing orders and interpretation counting towards the data component of MDM, let me ask this. In the past, you ordered some tests which your office was paid to do and you did the initial Interpretation and report. Since I'm an eye guy, let's say a visual fields test. The question is this: when the patient comes back for future visits and you look at these prior test results, for test you'd been paid to do, do you get credit at those future times for the data component for doing that?

Tom Cheezum, OD, CPC, COPC
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Good question. I don't think you can count it again if you already took credit for the order and interpretation in a prior visit. Otherwise, a provider could state they reviewed it and try to continue to get the same credit over and over again just for reviewing it. I think that would count more towards preparing to see the patient and reviewing your own past records.
 
chelsea.meetin@gmail.com said:
Regarding the data component - our pediatrics office uses the CLIA wavier and runs labs such as Covid PCR/antigens, Flu, Strep, etc. After reading more into the requirements for the data component, I'm not 100% confident in what is allowed. Since our doctors order these, the nurse swabs and runs the test in house, and the doctor reads the results, this still can not be used as a data component requirement. Is that correct? Or since we use the QW, does that change anything and allow us to include this, or does the data only include things like Xray, bloodwork labs, u/s, etc?
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www.aafp.org

Coding for Evaluation and Management Services: FAQs

Maximize payment and reduce stress by understanding how to properly document and code for evaluation and management (E/M) services.
www.aafp.org www.aafp.org
​

Can point-of-care labs (e.g., rapid strep, urinalysis) count as data elements when selecting the level of service using MDM?​

Yes, these tests are results-only tests that do not require separate interpretation and can be counted as ordered or reviewed as part of the data in MDM. This includes tests that were reported separately by the physician reporting the E/M service. The test would count as one data element—it could not be counted once as an order and again as a review of results.
Tests that require independent interpretation and report, such as X-rays, may not be used as data elements for MDM if the physician is reporting the test separately. However, as noted below, if the physician receives the test results from another physician (e.g., the radiologist who interpreted the X-ray), the physician providing the E/M service may count the review of those results as part of MDM.
 
amyjph said:

www.aafp.org

Coding for Evaluation and Management Services: FAQs

Maximize payment and reduce stress by understanding how to properly document and code for evaluation and management (E/M) services.
www.aafp.org www.aafp.org
​

Can point-of-care labs (e.g., rapid strep, urinalysis) count as data elements when selecting the level of service using MDM?​

Yes, these tests are results-only tests that do not require separate interpretation and can be counted as ordered or reviewed as part of the data in MDM. This includes tests that were reported separately by the physician reporting the E/M service. The test would count as one data element—it could not be counted once as an order and again as a review of results.
Tests that require independent interpretation and report, such as X-rays, may not be used as data elements for MDM if the physician is reporting the test separately. However, as noted below, if the physician receives the test results from another physician (e.g., the radiologist who interpreted the X-ray), the physician providing the E/M service may count the review of those results as part of MDM.
Click to expand...
Thank you so much! That puts my mind at ease!
 
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 who reports the E/M service is reporting or has previously reported the test.
A form of interpretation should be documented but need not conform to the usual standards of a complete report for the test.
A test that is ordered and independently interpreted may count both as a test ordered and interpreted.

If physician orders and bills for the EKG technical component (93005), and documents his 'informal' read "EKG shows sinus arrythmia with incomplete RBB, awaiting formal read", can he get credit for independent interpretation towards his E/M service same visit?
He did not bill for the professional component (93010) or global (93000) for which an interpretation/report IS customary. He billed CPT code (93005 tracing only) for which an interpretation/report is NOT customary.
And/or get credit for the order?

Appreciate your thoughts on this.
 
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