Wiki Category 2: Independent interpretation of tests - new 2021 documentation criteria

shortee3810

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Category 2: Independent interpretation of tests
Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported)

We are an orthopedic office and our physician interprets an X-ray from Urgent Care, does the X-ray interpretation of test qualifies under Category 2? If not, what imaging is approved under Category 2?


Thanks
 
Yes, that would qualify if your physician is actually viewing the image(s) (not just the report) and interpreting. This must be clear in the records. Something like:
"I viewed the left knee xray images from ABC urgent care taken 6/2/22 and agree with the diagnosis of insufficiency fracture of the left lateral condyle."
From the AMA 2021 Outpatient guidelines:
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.
 
Agree. They can't just review it. I suggest actually using the word interpreted and not just "reviewed". A lot of times I have seen, "I reviewed the X-Rays..." that's not the same thing as interpretation in my opinion. The advice above is great, it has to be the actual images not just the report.
 
Yes, that would qualify if your physician is actually viewing the image(s) (not just the report) and interpreting. This must be clear in the records. Something like:
"I viewed the left knee xray images from ABC urgent care taken 6/2/22 and agree with the diagnosis of insufficiency fracture of the left lateral condyle."
From the AMA 2021 Outpatient guidelines:
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.
What if the ortho ordered the X-ray? Or rather, gave the patient a requisition to go get an Xray done at an outside facility and did not bill for the xray. Could they still get credit for their independent interpretation of the images?
 
What if the ortho ordered the X-ray? Or rather, gave the patient a requisition to go get an Xray done at an outside facility and did not bill for the xray. Could they still get credit for their independent interpretation of the images?
Yes. There was a very recent update specifying the ordering physician may also get credit for independent interpretation if performed/documented. My interpretation prior was they could, but now it is in black and white.
Revise definition of “Independent interpretation” to add: “A test that is ordered and independently interpreted may count as both a test ordered and interpreted”
This is only for independent interpretation. Review is still included in the order.
 
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