“AI says I should have this test. Do I need it?” That question might come during an appointment, through the patient portal or by email. This guide covers the conversation itself, along with organizational policy, patient information, time and reimbursement.
A long answer may carry one concern. Start there before reviewing every claim.
“What prompted you to ask AI?”
“Which part concerns you most?”
“Are you asking about the test, the diagnosis or the next step?”
Assess urgency first. Then choose an appropriate setting.
When the question can be addressed safely with the available information.
When assessment, discussion or the amount of material requires more time.
When the patient’s symptoms or circumstances warrant prompt care.
Email: follow practice policy and direct clinical requests to the appropriate channel.
Compare the supplied information with the context needed for this decision.
Their question, symptoms or history, uploaded results and follow-up messages.
Relevant history, medicines and timing, examination findings, and prior results and trends.
Do the studies apply here? How strong is the evidence? Does it support this conclusion for this patient?
Evaluate the relevant suggestion using clinical context and evidence.
Decide what it would add. You do not have to run the question through another model.
Check approved tools, accounts, tasks and data rules. Approval for documentation may not cover clinical decision support. Confirm documentation and disclosure requirements.
Ask what remains unclear. Agree on the next step.
Read, check, interpret, explain.
Qualifying work may be reflected in E/M billing based on time or medical decision-making.
Some work may qualify for online digital E/M billing (CPT 99421: 5–10 minutes; 99422: 11–20; 99423: 21 or more, cumulatively over seven days). Not every message does. Check payer and service requirements.
Practices need triage, scheduling, documentation and consent processes. Employed clinicians also need the work recognized in workload and compensation.
A proposed discussion guide to adapt to your practice. The message example is hypothetical. Billing notes are for the United States.
The same suggestions as a 8-page guide you can print, share with colleagues or bring to an appointment.