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smithca

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Good morning,
I have 2 questions:
Labs being performed on equipment that is owned by practice can't be counted for data reviewed as they are being reimbursed already for the professional competent. Correct?
Stable Chronic Illness-specific treatment goals for the patient. Patient with HTN, takes Losartan daily. How can you be at treatment goal if you are taking a medication to control it?
Reviewing AMA guidance once again. Thank you for any guidance
 
Hi there,
1. If the tests require interpretation, you can't count them. If they are results-only you can. This is in the guidelines.
2. The treating provider determines whether the patient is at goal. If it isn't clear from the documentation you'll need to ask the provider.
 
You can read the full AMA 2021 guidelines here: https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
Specifically:
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. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The physician’s interpretation of the results of diagnostic tests/studies (ie, professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended. If a test/study is independently interpreted in order to manage the patient as part of the E/M service, but is not separately reported, it is part of MDM.
 
smithca said:
Interpretation would mean a report?
Click to expand...
No. It's easier just to ask whether the test is results-only. If it is, you can also count it toward MDM. If it isn't, and your practice billed for it, you can't.
 
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