Wiki Independent Interpertation

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arkolab

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What all needs to be documented in order to count an independent interpretation/review of an image (i.e x-ray,MRI,CT)? Does the provider need to document date, provider and facility to be able to count it?
 
We need to be able to plainly tell exactly which test the doc is looking at, especially if it's something like an ED/inpatient CXR/EKG where they could have multiple per day. "Pt had a CXR at 9am this morning. My personal review of the images show........" or "Pt had an EKG in the ER yesterday which, by my personal interpretation, shows......."

It should be noted if it's from an outside facility. "Pt brought CXR films performed 11/1/24 by his PCP. My interpretation shows...." or "I personally reviewed the CXR images performed at General Hospital on 11/10/24 which show........."
 
I have a question regarding giving credit for independent interpretation when it is coming from the ordering provider. We know that we can only give credit for the order and not the review of test results when it is by the same provider or group. But does that same concept apply in this case? Example: Ortho orders an MRI of the patient's knee. He got credit when he ordered that test. Now he is reviewing the film. Does he get credit for this at independent review?
 
wankmuka said:
I have a question regarding giving credit for independent interpretation when it is coming from the ordering provider. We know that we can only give credit for the order and not the review of test results when it is by the same provider or group. But does that same concept apply in this case? Example: Ortho orders an MRI of the patient's knee. He got credit when he ordered that test. Now he is reviewing the film. Does he get credit for this at independent review?
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Is he reviewing it or independently interpreting it?

When reviewing a film that the same provider ordered no, they cannot get credit for both ordering a reviewing the same image, as this is considered "double dipping" and is not allowed under the E&M coding guidelines.

We do not have a reading radiologist at our hospital, so the providers are reviewing the film and performing their own interpretation prior to the official read of a radiologist, then provider can count the independent interpretation as part of the data of their E/M under the independent interpretation column even if they are the one who ordered it, as long as they are not billing for the interpretation(which they don't).

Hope this makes sense!
 
arkolab said:
Is he reviewing it or independently interpreting it?

When reviewing a film that the same provider ordered no, they cannot get credit for both ordering a reviewing the same image, as this is considered "double dipping" and is not allowed under the E&M coding guidelines.

We do not have a reading radiologist at our hospital, so the providers are reviewing the film and performing their own interpretation prior to the official read of a radiologist, then provider can count the independent interpretation as part of the data of their E/M under the independent interpretation column even if they are the one who ordered it, as long as they are not billing for the interpretation(which they don't).

Hope this makes sense!
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Let's say he is not just reviewing the report, but looking at the films himself and making a determination for himself.
 
If the physician is viewing the images and documenting their findings, this does count as independent interpretation, even if they ordered the test.
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. A test that is ordered and independently interpreted may count both as a test ordered and interpreted
 
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