Wiki Counting of lab tests

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denisek1028

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I have a two part question regarding counting of lab tests.

1) if all the components of a panel are being ordered at the same time, but not the panel, (recommend using the "health panel" as an example) do we count that as one supporting data or three individual data elements. 2) if individual components of a panel are being ordered by a specialty through out the day (pieces ordered one at a time while individual colleagues of the same department are rounding on an inpatient), do we count those orders as one panel order or three indvidual orders?

Thank you!
 
Tests are counted by unique CPT code. A CBC measures about 20 different things but is treated as one test, because it's all included in 85205. That should help guide you.

If the intent in the second scenario is to order the panel (or most of it) but spacing out the tests for whatever reason, that should still be one code--or at least, that's in theory how it should be billed, because then you start to run into unbundling problems. Don't forget those 3 providers are also treated as the same doctor, if they're the same specialty and subspecialty, meaning if the first guy orders everything, the second and third guy don't get to credit it towards their own MDM.
 
tadailey said:
I was taught no matter the number of labs ordered/done it only counts as 1 data element. Same for radiology tests.
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This was the way under 1995 or 1997 guidelines. Those guidelines no longer apply and you must use AMA 2021 guidelines, which had some clarifications in 2023. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

I agree with @kdlberg that regardless of how they may have been incorrectly or piecemeal ordered, you count the tests ordered that day by CPT code.
 
Hi there, in general you can't get paid for a test and count it toward MDM. From the CPT manual:

The ordering and actual performance and/or
interpretation of diagnostic tests/studies during a patient
encounter are not included in determining the levels of
E/M services when the professional interpretation of
those tests/studies is reported separately by the physician
or other qualified health care professional reporting the
E/M service. Tests that do not require separate
interpretation (eg, tests that are results only) and are
analyzed as part of MDM do not count as an
independent interpretation, but may be counted as
ordered or reviewed for selecting an MDM level.
 
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