Evaluation and Management - Series Three
Date Posted: Sunday,
July 25, 2021
This is the third in the series for 2021 Evaluation and Management for Office/Outpatient Services and Prolonged Care.
This component is called Amount and/or Complexity of Data to be Reviewed and Analyzed. Previously, it was known as Amount and/or Complexity of Data. This component contains new requirements and definitions, and is the area of greatest change.
Clarification/Definitions
The status of new/established patient has not changed. In an instance when a physician/QHP is on call or covering for another physician/QHP, the patient’s encounter will be classified as it would have been by the physician/QHP who is not available. When advance practice nurses and physicians are working with the physician, they are considered as working in the exact same specialty and exact same subspecialities as the physician.
Test: Tests may be laboratory, imaging, and/or psychometric or physiologic data. The difference between single or multiple unique tests is defined by the CPT code set. For example, the CPT code 80047 is a basic metabolic panel and a single unique test.
AMA further clarified this, stating:
When the ordering and actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when the professional interpretation of these tests/studies is reported separately by the physician or other QHP reporting the E/M service. Tests that do not require separate interpretation (e.g., tests that are results only) and are analyzed as part of MDM do not count as an independent interpretation, but may be counted as ordered or reviewed for selecting an MDM level.
External physician or other QHP: This is a physician or other QHP who is not in the same group practice or is in a different specialty or subspeciality. It includes professionals that are practicing independently, whether in a facility or as part of an organized provider, such as a home health agency, nursing facility, or hospital.
Appropriate source: An appropriate source for this data element includes professionals who are not healthcare professionals but may be involved in the management of the patient. These may include a lawyer, officer, or teacher; however, they do not include discussion with family or informal healthcare caregivers.
Independent interpretation: When the interpretation of a test and an interpretation is customary. It is not applicable when the physician or QHP is reporting the service or has previously reported the service for your patient. There should be an interpreted documentation.
Maxine Lewis, CMM, CPC, CPC-I, CPMA, CCS-P, is a member of the National Society of Certified Business Consultants and is a nationally recognized lecturer, author, and consultant in the healthcare industry, combining more than 40 years of practical experience in the medical office with an in-depth understanding of coding, reimbursement, and management issues of the medical profession.
