Wiki E/M visit level

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hanihosni

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Hello,

It is stated in the note for an E/M visit that the provider discussed the patient's condition with the RN manager. Does that fall under the category of "discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)" in the MDM table ?

Hani E.
 
My understanding would be no in your example. A QHP would be someone who can also bill for services, and the RN manager would not qualify. Examples of QHPs could be NP, PA, CNM, PT, social workers. I would considers RNs as clinical staff members unless they are also filling a role making them an appropriate source (like an RN case manager for example).
From AMA 2023 guidelines:
External physician or other qualified health care professional: An external physician or other qualified health care professional who is not in the same group practice or is of a different specialty or subspecialty. This includes licensed professionals who are practicing independently. The individual may also be a facility or organizational provider such as from a hospital, nursing facility, or home health care agency.
Appropriate source: For the purpose of the discussion of management data element (see Table 1, Levels of Medical Decision Making), an appropriate source includes professionals who are not health care professionals but may be involved in the management of the patient (eg, lawyer, parole officer, case manager, teacher). It does not include discussion with family or informal caregivers.

Here's a good article on AAPC regarding the definition of QHPs:
 
so- for non qualified professional discussions the way you try to get reimbursed for that is to put towards the total time spent on that case for the day. you would then use time as a deciding factor if it's higher than your MDM.
 
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