Wiki E/M Data Reviewed Points HELP

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kitkatcoder

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Can you tell me what the 1997 guidelines where it says that you can count EACH X-ray ordered each point for Data Reviewed points.

Example: Chest x-ray was negative, Lower extremity x-ray showed fracture, CT Scans wee ordered..


Do you count that 1 point for x-ray, 1 point for lower x-ray, and 1 for CT scan ordered.

If wrong or write can you point me in right direction to show them this...

Thanks,
 
Dr. Jensen's website (E/M University) states it well...


Data Points

The “amount and complexity of the data reviewed” are quantified by referring to the following table:

Data Reviewed Points

Review or order clinical lab tests 1
Review or order radiology test (except heart catheterization or echo) 1
Review or order medicine test (PFTs, EKG, cardiac echo or catheterization) 1
Discuss test with performing physician 1
Independent review of image, tracing, or specimen 2
Decision to obtain old records 1
Review and summation of old records 2

The physician should be aware that no “double dipping” is allowed. For example, if you review lab results and order labs during the same visit, you only get one point (not one point for ordering and one point for reviewing). This same rules applies to imaging studies or other medicine tests such as EKGs or PFTs. Commonly overlooked points are those garnered for obtaining or reviewing old records. If you do review old records, you must summarize your findings in the chart. It is not acceptable to just say, “Old records were reviewed.”

http://emuniversity.com/MedicalDecision-Making.html
 
so here is a dumb question how do you decipher if it was an independent review of image....

for example if he says bilateral lower extremity x-rays reveal talar dome fracture. chest x-ray was negative for pneumothorax.... would you intrepret that as an independent review of image? Or does he have to say have films and it showed..blah, blah...
 
also...i have something that says

Independent visualization and interpretation of an image, EKG or laboratory specimen not reported for separate payment.
Note: Each visualization and interpretation is allowed one point.

so if I am coding for x-ray w/26 modifier I can NOT count this towards Reviewed data points because he is getting seperate payment correct?
 
Not a dumb question at all...

An independent review is when your provider interprets and provides a formal interpretation of outside images (MRI, CT, etc) that someone else-outside the group- has already ordered and formally interpreted.

Example: Within our practice, we have neurosurgeons. At the patient's initial visit, the surgeon reviews an outside CD (MRI, CT, etc). Our surgeons reviews the images and provides a formal interpretation of the scan. This is considered an independent review.
 
Last edited:
rebeccawoodward said:
Not a dumb question at all...

An independent review is when your provider interprets and provides a formal interpretation of outside images (MRI, CT, etc) that someone else-outside the group- has already ordered and formally interpreted.

Example: Within our practice, we have neurosurgeons. At the patient's initial visit, the surgeon reviews an outside CD (MRI, CT, etc). Our surgeons reviews the images and provides a formal interpretation of the scan. This is considered an independent review.
Click to expand...

Rebecca: What about reviewing an EKG or cxr? At our institution, no one reads the EKG's ordered in house or telemetry. I read my own tracings. Often, I read my own chest films as they won't be read until the following day (officially) by a Radiologist. I have been counting EKG's, plain films and telemetry. Is this wrong?
 
If a provider bills for the global component or the professional component only, credit should not be given (independent vis.) if the provider is being paid for the interp.

Excerpt from DG's:

The direct visualization and independent interpretation of an image, tracing or specimen previously or subsequently interpreted by another physician should be documented.


https://www.cms.gov/MLNProducts/Downloads/MASTER1.pdf
Page 50


An interpretation is “independent” when it is separate from and in addition to a primary interpretation performed by another physician. Below is a Q/A from Highmark-


Highmark:

Q: If a provider is billing for the professional component of a test in the radiology and/or medicine section of the Current Procedural Terminology (CPT) Manual and an Evaluation & Management (E/M) procedure code on the same date of service, should that physician receive credit under the Independent Visualization of an image, specimen or tracing component in the Amount and /or Complexity of Data Reviewed Section of the Medical Decision Making key component of an E/M?

A: If the provider is billing separately for the interpretation of a test in the radiology and/or medicine section of the CPT, then that same physician should not take credit for the independent visualization of that test in the Amount and /or Complexity of Data Reviewed Section of the Medical Decision Making key component of an E/M.

If the provider is not billing separately for the interpretation of the test or the test was performed by another provider and that physician is independently visualizing the test, then the provider may take credit for the independent visualization of that test in the Amount and /or Complexity of Data Reviewed Section of the Medical Decision Making key component of an E/M.

https://www.highmarkmedicareservices.com/partb/em/independent-visualization.html

This is often a debatable subject and I always recommend contacting your carrier for their recommendations.
 
http://www.emuniversity.com/COW/case022409.pdf

Another question... admistrator is totally disagreeing with me regarding counting Data Reviewed Points. This link was sent to me and if you look at it shows they are counting each one..

One point for labs, two points for reviewing the CT scan (and recording interpretation in the note). Also two points each for reviewing the MRI and the EKG. One point for ordering the carotid doppler studies. This adds up to a whole lot of data points (8 data points to be exact!).
 
But...It doesn't state HE ordered the studies. This could have been ordered in the ER and he is providing an interp based on those studies ordered by another physician.
 
Follow up

AK - the physician cannot take credit for the visualization of a test conducted on the same DOS in the Data Points, but can he/she take credit for ORDERING the procedure in the data points?


Thanks

Lin
 
Claification in Data points

If the physician Orders for labs it qualifies for 1 point.

Please clarify if the same physician Cancel the order latter.

1. Due to Patient not willing or not affordable.
2. Due to Physician decision on not necessary for labs.

Thanks much,
 
RebeccaWoodward* said:
Correct...

Order of 2V CXR, 1V of shoulder, and 1V of the hip= 1 point
Click to expand...


Quick question on this... I see this is an older thread, but I'm having a hard time finding this information anywhere.
Does it matter if all images reviewed were x-rays or if the physician reviewed X-ray AND an US or CT, etc...?
Basically, is this 1 point regardless number of images or types of imaging within the radiology section?
 
The provider can only be credited 1 point for ALL information reviewed/ordered of that type of information (labs, radiology, medical studies, etc.). The only exception to this rule, would be if the physician Independently reviewed the studies/images before another expert could review and document. This would typically require the provider to state in his/her own words what the report indicated.


Hope this helps!
 
Independent review of films AND radiologist report

Hi,
If a provider documents that he personally view the xray films/scans and documents his impression. He then reviews the radiologist report/impression and documents that information. He now compares the 2 impressions and documents that information. Would he get 2 data points for independent visualization of xray films/scans w/ impression and another (1) data point for review of the radiologist report/impression? The has documented that he has done the work of 2 separate actions. Or would this be double dipping?

Thanks in advance:)
Kelly
 
Hello,

Because the provider is using the same study, I would go with the Independent Review only. The CMS E/M guidelines explain:

"DG: The direct visualization and independent interpretation of an image, tracing, or specimen previously or subsequently interpreted by another physician should be documented. "

Because of the description of the above, this action suggests that the provider is already reading the study "previously interpreted by another physician", thus counting both the Independent Review AND review of the report, would in my opinion be "double dipping".

Hope that helps!
 
Independent review of films AND radiologist report

Yes that was very helpful.

Thank you!!
 
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