shortee3810
Networker
According to the 2021 MDM guidelines, column 2, under category 1, what qualifies a unique test? We see that it has an asterisk next to unique test with no explanation.
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What qualifies a unique test
- Thread starter shortee3810
- Start date
lgardner
Expert
per AMA:
Unique: A unique test is defined by the CPT code set. When multiple results of the same unique test (eg, serial blood glucose values) are compared during an E/M service, count it as one unique test. Tests that have overlapping elements are not unique, even if they are identified with distinct CPT codes. For example, a CBC with differential would incorporate the set of hemoglobin, CBC without differential, and platelet count. A unique source is defined as a physician or qualified heath care professional in a distinct group or different specialty or subspecialty, or a unique entity. Review of all materials from any unique source counts as one element toward MDM.
Unique: A unique test is defined by the CPT code set. When multiple results of the same unique test (eg, serial blood glucose values) are compared during an E/M service, count it as one unique test. Tests that have overlapping elements are not unique, even if they are identified with distinct CPT codes. For example, a CBC with differential would incorporate the set of hemoglobin, CBC without differential, and platelet count. A unique source is defined as a physician or qualified heath care professional in a distinct group or different specialty or subspecialty, or a unique entity. Review of all materials from any unique source counts as one element toward MDM.
shortee3810
Networker
If a physician reviews an MRI report from a radiologist, does this qualify as an independent interpretation of a test for level of MDM?
Reviewing the MRI report (if you did not order the test) is just that - reviewing a result. Review of 1 test in Category 1 data.
If a physician reviews the IMAGES and INTERPRETS them, that is independent interpretation of a test. Category 2 - Independent interpretation of tests.
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 is reporting the service or has previously reported the service for the patient. A form of interpretation should be documented but need not conform to the usual standards of a complete report for the test.
Virtually all these types of questions can be answered by reading, re-reading, re-reading, re-reading, and then re-reading the AMA 2021 Outpatient Guidelines.
If a physician reviews the IMAGES and INTERPRETS them, that is independent interpretation of a test. Category 2 - Independent interpretation of tests.
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 is reporting the service or has previously reported the service for the patient. A form of interpretation should be documented but need not conform to the usual standards of a complete report for the test.
Virtually all these types of questions can be answered by reading, re-reading, re-reading, re-reading, and then re-reading the AMA 2021 Outpatient Guidelines.
BROCSurgical
New
No. They cannot just read a report that already has an interpretation. They would have to view the images and make their own separate interpretation report.
wturner
New
Unique test question: if a test for Flu A&B are ordered using CPT code 87804, they are reviewed in house, is this counted as two unique test or 1 unique test reviewed? I am not talking about billing but counting for data points.
The AMA E&M guide answers this. One CPT is one data test.
Test: Tests are imaging, laboratory, psychometric, or physiologic data. A clinical laboratory panel (eg, basic metabolic panel [80047]) is a single test. The differentiation between single or multiple tests is defined in accordance with the CPT code set. For the purpose of data reviewed and analyzed, pulse oximetry is not a test.