News: AMA summarized reporting changes outpatient coding teams can expect

New evaluation and management (E/M) changes are on their way in 2024 and 2025, according to a summary recently published by the American Medical Association (AMA). It outlines many recent changes to the 2023 CPT Manual that outpatient coding teams should be aware of as well, HealthLeaders reported.

Two important changes (in bold below) in the section, “Amount and/or Complexity of Data to be Reviewed and Analyzed” reads:

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 healthcare 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.

Appropriate source: For the purpose of the discussion of management data element (see Table 1, Levels of MDM), an appropriate source includes professionals who are not healthcare professionals but may be involved in the management of the patient (e.g., 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.

“The most recent CPT errata’s clarification regarding the counting of data elements is a bit surprising,” Shannon McCall, director of HIM and coding at HCPro, said in an interview with Part B News. “In EDs, especially after hours, it is not uncommon for multiple tests (imaging, labs, etc.) to be ordered and those orders may very well include ones that are eligible for independent interpretation.”

McCall said coders should remember that another two elements, whether number and complexity of problems addressed or risk of morbidity, must also be met to classify overall medical decision making (MDM). The change may increase reporting of emergency department (ED) codes 99284, “ED visit for the E/M of a patient,” and 99285, “ED visit for the E/M of a patient,” which both require a medically appropriate history and/or examination and either a moderate or high level of MDM, she stated.

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To read the CPT Editorial Summary of Panel Actions, click here.