Question: Can a practitioner get credit for both ordering and interpretation of a test if documented? Can you address the change from 2023 related to this?
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Answer:
In March of 2023, CPT® issued an “Errata and Technical Corrections” which added one line to the section on Independent Interpretations. That change is in the printed copy of the 2024 and, of course, the 2025 book. It reads “A test that is ordered and independently interpreted may count both as a test ordered and interpreted.”
Let’s review independent interpretation.
An independent interpretation is credited when a physician or other health care professional views an image or tracing and uses the information to make clinical decisions. The practitioner documents their interpretation. Another physician, usually a radiologist, was or will be paid for the formal interpretation.
The test must be described with a CPT® code and must typically have a report; that is, a test with a professional and technical component. The E/M. performing physician can receive credit for their independent interpretation only if they or someone in their specialty does not intend to bill globally for the service or for the professional component (-26) (the interpretation). For example, a surgeon views an ultrasound or a CT scan that a radiologist has (or will) formally review, and the surgeon documents their findings. Credit an independent interpretation for the surgeon performing the E/M visit at which the image is viewed, interpreted, and documented.
Which brings us back to our question about the change to “independent interpretation”, in 2023. Can the provider get credit for both ordering and interpretation, if documented? Yes, using the example above, the surgeon could still get credit for the interpretation of the CT scan, even if they ordered the CT scan and when a radiologist is billing for the interpretation.
Conversely, an orthopedist will view an X-ray taken at their own practice months or years ago and billed globally by the practice. That would not qualify as an independent interpretation because their same specialty partner did the professional interpretation.