Wiki New Outpatient E/M put out by AMA March 2023

[catcate]

Independent interpretation - What does this mean "This does not apply when the physician or other qualified health care professional who reports the E/M service is reporting (or has previously reported) the test"? Does this mean when doing a note and reporting the E/M, the date interpretation doesn't apply?
If you had a patient being seen for Strep throat and did a swab and it came back positive, you count it has a test but you can't count it as a review of test , correct?

Thanks for all your help!

 

[csperoni]

I think you may be confusing a few different concepts here. "Independent interpretation" is distinctly different than order/review. You cannot count an order/review of a test you perform if there is a professional component.

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 who reports the E/M service is reporting or has previously reported the test. A form of interpretation should be documented but need not conform to the usual standards of a complete report for the test.
Independent interpretation is used for when the clinician personally looks at the images/findings of an outside test and comes to their own conclusion. Independent interpretation would be a physician who did not perform/bill for the test personally views the xray/CT/MRI/ultrasound images and draws/documents their own conclusion. Common scenarios - an ER clinician doing a wet read of an xray while awaiting formal radiology interpretation; a surgeon viewing CT images to see if the location of the injury or mass is amenable to surgical access. If an orthopedist does an xray in office and reads it, this is not independent interpretation as the ortho is being paid for the interpretation already by billing the xray itself.

All tests (excluding those you bill and have a professional component) should be counted when ordered. The review is included and not counted again. You may count review of test that another practice ordered, or that were ordered not during an encounter.

In your example of a strep test, there cannot be any independent interpretation as it is a lab result, therefore no interpretation or report is customary. Labs that have a result only (no professional component), you may count the order/review even if you are performing the test. The strep test would be counted at order and the review is included.

I hope this helps better explain it for you.

 

[sls314]

I think you may be confusing a few different concepts here. "Independent interpretation" is distinctly different than order/review. You cannot count an order/review of a test you perform if there is a professional component.

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 who reports the E/M service is reporting or has previously reported the test. A form of interpretation should be documented but need not conform to the usual standards of a complete report for the test.
Independent interpretation is used for when the clinician personally looks at the images/findings of an outside test and comes to their own conclusion. Independent interpretation would be a physician who did not perform/bill for the test personally views the xray/CT/MRI/ultrasound images and draws/documents their own conclusion. Common scenarios - an ER clinician doing a wet read of an xray while awaiting formal radiology interpretation; a surgeon viewing CT images to see if the location of the injury or mass is amenable to surgical access. If an orthopedist does an xray in office and reads it, this is not independent interpretation as the ortho is being paid for the interpretation already by billing the xray itself.

All tests (excluding those you bill and have a professional component) should be counted when ordered. The review is included and not counted again. You may count review of test that another practice ordered, or that were ordered not during an encounter.

In your example of a strep test, there cannot be any independent interpretation as it is a lab result, therefore no interpretation or report is customary. Labs that have a result only (no professional component), you may count the order/review even if you are performing the test. The strep test would be counted at order and the review is included.

I hope this helps better explain it for you.

As another example, my radiation oncologists commonly do independent interpretation of CT/MRT/PET scans. They review and draw their own conclusions about the size and location of suspected (or confirmed) malignancies, using their expertise as oncologists.

The facility's reading radiologist bills for the professional component of the imaging. The interpretation done by the radiation oncologist is factored into the MDM for that visit.