Independent visulalization of image, tracing or specimen itself

We are currently researching how many points we can count if our providers order and then read the x-ray films during the patient's visit. I know Margie was telling us that it would only be worth 1 point, not 2. Does anyone know of any examples of what would qualify for the independent visualization of image for e/m level?

Comments

  • 3 total is what we were told in Orlando at AAOS seminar, the past Saturday. 1 for ordering and 2 for reviewing the film.

    Lynn Spille, CPC
    Clinical Coding/Billing Specialist
    “The Team Behind the Team”
    T (850)219-1924 |  (850)219-1899 | | lynn.spille@tlhoc.com
  • You will need to be doing an independent review of someone else's
    interpretation -
    I also received from an office in Maryland this from their Medicare
    carrier: "A representative from the Medicare Auditing team stated that we cannot
    get MDM credit if we order, perform and read the x-ray within an office
    visit, because it is covered under the reimbursement for the x-ray? She
    directed us to this information on the FAQ but I do not see anything listed that
    states we cannot get MDM credit for an x-ray that we charge for in the
    same visit."

    In the MDM - CMS has been clear that in order to get the extra points they
    have to be doing an independent visualization that SOMEONE else gave the
    'official interpretation' for originally. They can't be independent to
    themselves.


    The official guidelines state:
    AMOUNT AND/OR COMPLEXITY OF DATA TO BE REVIEWEDThe amount and complexity
    of data to be reviewed is based on the types of diagnostic testing ordered
    or reviewed. A decision to obtain and review old medical records and/or
    obtain history from sources other than the patient increases the amount and
    complexity of data to be reviewed.

    Discussion of contradictory or unexpected test results with the physician
    who performed or interpreted the test is an indication of the complexity of
    data being reviewed. On occasion the physician who ordered a test may
    personally review the image, tracing or specimen to supplement information from
    the physician who prepared the test report or interpretation; this is
    another indication of the complexity of data being reviewed.
    * DG: If a diagnostic service (test or procedure) is ordered,
    planned, scheduled, or performed at the time of the E/M encounter, the type of
    service, eg, lab or x-ray, should be documented.
    * DG: The review of lab, radiology and/or other diagnostic tests
    should be documented. A simple notation such as WBC elevated or chest x-ray
    unremarkable is acceptable. Alternatively, the review may be documented by
    initialing and dating the report containing the test results.
    * DG: A decision to obtain old records or decision to obtain
    additional history from the family, caretaker or other source to supplement that
    obtained from the patient should be documented.
    * DG: Relevant findings from the review of old records, and/or the
    receipt of additional history from the family, caretaker or other source to
    supplement that obtained from the patient should be documented. If there is
    no relevant information beyond that already obtained, that fact should be
    documented. A notation of Old records reviewed or additional history
    obtained from family without elaboration is insufficient.
    * DG: The results of discussion of laboratory, radiology or other
    diagnostic tests with the physician who performed or interpreted the study
    should be documented.
    * DG: The direct visualization and independent interpretation of an
    image, tracing or specimen previously or subsequently interpreted by
    another physician should be documented.


    http://www.trailblazerhealth.com/Publications/Job Aid/coding pocket re
    ference.pdf
    Independent visualization and interpretation of an image, EKG or
    laboratory specimen not reported for separate payment.
    Note: Each visualization and interpretation is allowed one point.




    Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
    Auditing, Coding, Documentation and Compliance Consulting
    Healthcare Consultant_ scalley123@aol.com_ (mailto:scalley123@aol.com)
    cell 360-880-8304
    fax 413-674-7668_www.margievaught.com_ (http://www.margievaught.com/)
    facebook: margie s vaught
    for workshops and audio_ http://www.margievaught.com/calendar/index.cfm_
    (http://www.margievaught.com/calendar/index.cfm)
    Want to receive a monthly newsletter - signup on_ margievaught.com_
    (http://margievaught.com/)
    Check the calendar for audios/webinars and live presentations already
    scheduled - 2017 
  • edited May 2017
    so you're saying an x-ray ordered and read in the office is worth 1 point but if outside films are brought in from another place and read it is worth 2 points?
  • Per the 1995 and 1997 documentation guidelines is where this information
    is coming from along with additional information from the Medicare carriers.

    If you are billing the global code for imaging that you ordered during
    that encounter, that means that you are billing for the official
    interpretation of those images.

    In order to 'met' the additional "points" there has to be an independent
    visualization of a previously interpreted image. How can you independent to
    yourself? If you or your partner provided the official interpretation of
    a given image you can't be 'independent' as you are related.

    But let's say that you see a patient and you decide to order an MRI at a
    facility that is not yours - for that encounter you can get the one point
    for ordering. When the patient returns with the results of the MRI and your
    provider then takes those films and does their own independent and
    documented interpretation you can get the two points. If however your provider just
    reviews the interpretation of the MRI from the radiologist then you don't
    get the 2 points.

    Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
    Auditing, Coding, Documentation and Compliance Consulting
    Healthcare Consultant_ scalley123@aol.com_ (mailto:scalley123@aol.com)
    cell 360-880-8304
    fax 413-674-7668_www.margievaught.com_ (http://www.margievaught.com/)
    facebook: margie s vaught
    for workshops and audio_ http://www.margievaught.com/calendar/index.cfm_
    (http://www.margievaught.com/calendar/index.cfm)
    Want to receive a monthly newsletter - signup on_ margievaught.com_
    (http://margievaught.com/)
    Check the calendar for audios/webinars and live presentations already
    scheduled - 2017 
  • We are having a disagreement in our office regarding assigning 2 data points for "independent review of image, tracing or specimen" in the following scenario. We are a large multispecialty clinic and we employee radiologists who perform and bill for the global components of x-rays. So, if a Family Practice provider orders an xray and then reviews the actual image and states that he independently reviewed the image and the patient has pneumonia, or notes that a bone is broken, or whatever, does that support 2 points for independent review? (The xray will later be read and officially interpreted by the radiologist). Or is this captured in the 1 point assigned for review and/or order tests in the Radiology section? And if the 2 points are allowed in this case, can we also give 1 point for ordering/reviewing making a total of 3 points? If  2 points are allowed for this, how detailed would his documentation of what he sees in the xray need to be?
  • If the provider who is ordering the films is also billing for the films then the provider may only capture 1 point for the decision to order films and no points for the interpretation. It is not considered independent if the global billing is done by the same provider. His professional interpretation is reimbursed in the global radiology billing (TC/26).
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