Wiki External notes from each unique source

[ttompsett]

For the 2023 E/M guidelines, data section, category 1, "Review of prior external note(s)" from each unique source*"-- if the provider reviewed an external note from Cardiology, and an external note from GI- two unique sources- would this be 2 points? Thank you!

 

[csperoni]

Yes, that would be 2 points. Each provider/group would be a unique source.
If the provider read a cardio note, and read the cardio's echo report, then it is 1 point.
If the provider read cardioMD1 note, and partner cardioMD2 note, that is also 1 point as both cardioMD1 and cardioMD2 are the same group, so one source.

 

[jeskla]

We have many mid levels at our multi-specialty practice. Some are dedicated to one physician and others run the quick care clinic where they see walk in patients who have injuries. After they see the patient, they schedule a follow up appt with a orthopedic surgeon, pain management, or podiatrist. Does the ortho surgeon, pain management, podiatrist get one data point for reviewing the mid levels note? Sometimes this makes a difference between a level 2 and a level 3.

I have been telling the physicians no based off the below, but am getting a LOT of pushback saying ..."working with" means they are working with me that day. I respond saying mid levels are not a unique external source.

"In the instance where a physician or other qualified health care professional is on call for or covering for another physician or other qualified health care professional, the patient’s encounter will be classified as it would have been by the physician or other qualified health care professional who is not available. When advanced practice nurses and physician assistants are working with physicians, they are considered as working in the exact same specialty and subspecialty as the physician."

 

[csperoni]

This is getting into a grey area if you have a multi-specialty practice with NPPs sometimes working for one specialty, and sometimes working for another. When they "run the quick care clinic", who/what specialty is their supervising provider? For example, if ortho physicians oversee the quick care clinic, then I would consider those NPPs working in ortho. If that patient is then later seen by pain management or podiatry, I would count the NPP note as an ortho note and credit 1 data point. If the records are not clear that the mid level is working in a different specialty/subspecialty than the provider they are seeing, I would not count it.
Excerpts from AMA E/M guidelines:
"A unique source is defined as a physician or other qualified health care professional in a distinct group or different specialty or subspecialty"
"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."