Wiki Amount and/or Complexity of Data to be Reviewed and Analyzed - middle Column of E&M table

[subashree.pandiarajan@gmail.com]

I work with a physician group. We are trying to find resources that describes "Each unique test" in the middle column of E&M table. If a provider orders 3 tests which has 3 different CPT codes satisfy Category 1: Tests, documents, or independent historian(s) under moderate level, even though the provider didn't review its results or review any external notes or didn't utilize independent historians for history taking? Where can I find resources that supports it? Thank you for your help.

 

[csperoni]

https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

Analyzed: The process of using the data as part of the MDM. The data element itself may not be
subject to analysis (eg, glucose), but it is instead included in the thought processes for diagnosis,
evaluation, or treatment. Tests ordered are presumed to be analyzed when the results are
reported. Therefore, when they are ordered during an encounter, they are counted in that
encounter. Tests that are ordered outside of an encounter may be counted in the encounter in
which they are analyzed. In the case of a recurring order, each new result may be counted in the
encounter in which it is analyzed. For example, an encounter that includes an order for monthly
prothrombin times would count for one prothrombin time ordered and reviewed. Additional
future results, if analyzed in a subsequent encounter, may be counted as a single test in that
subsequent encounter. Any service for which the professional component is separately reported
by the physician or other qualified health care professional reporting the E/M services is not
counted as a data element ordered, reviewed, analyzed, or independently interpreted for the
purposes of determining the level of MDM.
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.
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 other
qualified health 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

 

[subashree.pandiarajan@gmail.com]

https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

Analyzed: The process of using the data as part of the MDM. The data element itself may not be
subject to analysis (eg, glucose), but it is instead included in the thought processes for diagnosis,
evaluation, or treatment. Tests ordered are presumed to be analyzed when the results are
reported. Therefore, when they are ordered during an encounter, they are counted in that
encounter. Tests that are ordered outside of an encounter may be counted in the encounter in
which they are analyzed. In the case of a recurring order, each new result may be counted in the
encounter in which it is analyzed. For example, an encounter that includes an order for monthly
prothrombin times would count for one prothrombin time ordered and reviewed. Additional
future results, if analyzed in a subsequent encounter, may be counted as a single test in that
subsequent encounter. Any service for which the professional component is separately reported
by the physician or other qualified health care professional reporting the E/M services is not
counted as a data element ordered, reviewed, analyzed, or independently interpreted for the
purposes of determining the level of MDM.
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.
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 other
qualified health 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

Thank you for the response.