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Moderate - Cat 1 Clarity

J

jenniferdchism

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Pasco, WA
If a provider ordered a test and it was later reviewed by another provider in the same office they would not receive credit in MDM as it was credited to the ordering provider… when would a provider ever get credit for reviewing a test? It would have to be from an outside source and at that point wouldn't it be considered independent interpretation? Please share your thoughts! These new guidelines are wild!
 
That is a good question. I would feel that since it is a different provider, the provider reviewing the results would get credit as well for reviewing them, but if the same provider ordered and reviewed the results they would only get credit for one part. Have you found any more information about this since you posted this question? I would love to know the correct way.
 
If 2 physicians in the same group practice of the same specialty review a test that was ordered by 1 of them, you give credit for the ordering, and no one gets credit for reviewing (which is included in the order). Similarly, if you re-review a test 2 years later, you do not count it again.
I recall reading (but cannot find the reference now) If 2 physicians in the same group practice of different specialties review a test that was ordered by 1 of them, the physician who ordered gets credit for ordering (with review included). The other physician of a different specialty may also get credit for review. Example: Pt sees her PCP (family practice), who orders abdominal MRI. Results are abnormal, and patient now being seen by GI in same group. The GI can count review of the MRI.

Independent interpretation requires more than reviewing a test result. Example: MRI ordered by outside physician.
Your physician reviews the written report = review result of test
Your physician views the CD images and interprets the images = independent interpretation of test
Something like simple lab results cannot have independent interpretation, but could have review if you did not order them.

The AMA guide is a great reference and addresses some of these questions officially. https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
 
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