AMA updates two data definitions, hints at changes in 2024 and beyond

1. 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.
2. Appropriate source: For the purpose of the discussion of management data element (see Table 1, Levels of Medical Decision Making), an appropriate source includes professionals who are not health care professionals but may be involved in the management of the patient (eg, lawyer, parole officer, case manager, teacher). It does not include discussion with family or informal caregivers. For the purpose of documents reviewed, documents from an appropriate source may be counted.

“A patient is considered an outpatient until inpatient admission to a health care facility occurs.”

Part B News subscribers can download the new worksheet for level-based E/M visits.

• All office/other outpatient visits that have a time element (99202-99205 and 99212-99215).
• Two nursing facility codes (99306 and 99308).

• Split or shared visits and multiple evaluation and management services on the same date.
• Initial hospital inpatient or observation care/new or established patient.
• Hospital inpatient or observation care services, including admission and discharge.
• Prolonged services with or without direct patient contact on the date of an E/M service.