Wiki 2021 E/M Changes: MDM Data Component

[KStaten]

Hello, Everyone!

I would greatly appreciate if someone could either confirm or correct my understanding of the new E/M guidelines.

Scenario 1: A physician orders and reviews x-rays at his office during a visit. It is to my understanding that if the x-ray is billed with a CPT code, then this can NOT be counted towards part of the data component of the MDM. Correct?

Scenario 2: A physician orders an MRI (to be performed by an outside source) during the initial visit and reviews the results of the MRI during the subsequent visit. It is to my understanding that this can ONLY count as 1 point towards the data component of the MDM during the initial visit and can NOT be counted as a point during the subsequent visit as part of the MDM (as review of data). Correct?

As always, I appreciate your advice/input.

Thank you in advance,
Kim

 

[csperoni]

You are correct on both scenarios.
The theory is that if you are performing a test which also includes a professional component, then you are being adequately reimbursed by billing for the test. Counting it toward data would be considered double dipping since you are receiving credit by billing for the test itself. Note that tests with no professional component may be counted when performed on site and billed (recent clarification by AMA.)
For test, you may count the order or review but not both for the same test. Generally, you should count the order, and review is included. If there are tests ordered between visits and you are not receiving credit for the order, you may then count the review.

 

[KStaten]

You are correct on both scenarios.
The theory is that if you are performing a test which also includes a professional component, then you are being adequately reimbursed by billing for the test. Counting it toward data would be considered double dipping since you are receiving credit by billing for the test itself. Note that tests with no professional component may be counted when performed on site and billed (recent clarification by AMA.)
For test, you may count the order or review but not both for the same test. Generally, you should count the order, and review is included. If there are tests ordered between visits and you are not receiving credit for the order, you may then count the review.

Thank you so much, Christine. Confirmation is always appreciated so that I don't overthink... or underthink.