Table B: Amount and/or Complexity of Data to Be Reviewed and Analyzed
The "amount and/or complexity of data to be reviewed and analyzed" refers to how much and how complicated the information is that healthcare providers need to look at during a patient visit. This includes things like medical records, test results, and other information that helps them make decisions about the patient's care.
The complexity of the data can change based on things like how many tests or documents they need to review, where the information is coming from, and if they need to talk to other healthcare providers or outside sources.
Straight forward (None) and Low Complexity data (minimal)
Moderate Data Complexity
Some points to consider in ordering and reviewing:
In medical coding, ordering a test is considered part of the test result category, and reviewing the test results is part of the overall encounter. It's assumed that a physician or other qualified healthcare professional (QHP) will review the results of any test they order. Because of this, it's generally best practice to give credit for ordering the test rather than for reviewing it. In other words, you can give credit for either ordering or reviewing the test, but not both, when determining the level of medical decision making (MDM) for the service.
Please note that providers of the same specialty, are considered a single physician. This is confirmed in the CPT Assistant FAQ.
Question: If you order a CT scan at a visit on June 10 and review it with the patient at a follow-up visit on June 17, you would count the order on the 10th and the review on the 17th. This applies even if you did not bill for the CT scan or its interpretation.
Answer: No, count only once.
Question: In a cardiology practice, if my cardiology partner completes the official echo report and bills for it, but I later see the patient and interpret the echo, can I consider this an independent interpretation?
Answer: No, you cannot. If your cardiology partner, who is also in the same specialty as you, reported the professional component and billed for it, you should not credit an independent interpretation when you see the patient. But yes, you can consider the interpretation in MDM when another group of physicians had interpreted the echo.
What is mean by unique test?
A unique test is defined by the CPT code set. When a doctor compares multiple results of the same unique test (like checking blood sugar levels several times), it is counted as just one unique test, even if there are multiple results. However, tests that have parts that overlap with each other are not considered unique, even if they have different codes.
For example, a complete blood count (CBC) with a differential test includes checking hemoglobin, a CBC without a differential, and platelet count. Even though these tests have different codes, they are not considered unique because they share some of the same elements.
Example:
Let's say a provider orders an electrolyte panel (CPT code 80051), which includes four individual tests: carbon dioxide (bicarbonate) (CPT code 82374), chloride (CPT code 82435), potassium (CPT code 84132), and sodium (CPT code 84295). Despite including multiple tests, the electrolyte panel is considered one unique test, not four.
Similarly, if a provider orders serial glucose testing over several hours or days and compares the results during an E/M service, even though the same test is repeated multiple times, it counts as one unique test.
On the other hand, tests that have overlapping elements are not considered unique, even if they have distinct CPT codes. For example, a CBC with differential and a CBC without differential would be considered one unique test because they have overlapping components.
EKG Coding
TO bill the EKG, following 2 points must be met.
Interpretation done the provider. Statement or similar verbiage must be documented.
Each billable EKG should have at 3 points from the following: -
Rate
Rhythm
Comparison with prior EKG
PR wave Interval
ST segment change
QRS complex
Summary of clinical Condition
High Data Complexity
