Henson65
Networker
Hi all,
Due to the 2021 EM updates for office visits with the coding assignment based upon MDM, there was a question that came up in one of my meetings with clinical leadership regarding the unique tests. Currently, our organization orders and performs the testing in clinic (Xray, POCT, ect) so we know these are not considered unique tests since the test is billed/reimbursed with the appropriate CPT code. So, the question came up what if the organization would only bill for the technical portion, specifically for Xrays....could the provider utilize the review/interpretation of the xray when considering MDM. I know this is a very grey area and my first response was no since the Xray would not be considered a unique test, however the interpretation would not be billed by my providers so I can see why they would be asking this question. Of course the xray would go to an outside party for a final read, our providers would just be providing a preliminary read but again we would not be billing for that professional component. It seems by definition this scenario would be excluded as some part of the testing would be billed/reimbursed by our organization. I've tried looking into this with reputable sources and cannot find any solid evidence to confirm nor deny the assumptions so thought I would reach out for other coders opinions. Of course the providers are hard set on this as the unique test qualifier can definitely impact the overall MDM.
Any thoughts/opinions/supporting evidence would be greatly appreciated.
Due to the 2021 EM updates for office visits with the coding assignment based upon MDM, there was a question that came up in one of my meetings with clinical leadership regarding the unique tests. Currently, our organization orders and performs the testing in clinic (Xray, POCT, ect) so we know these are not considered unique tests since the test is billed/reimbursed with the appropriate CPT code. So, the question came up what if the organization would only bill for the technical portion, specifically for Xrays....could the provider utilize the review/interpretation of the xray when considering MDM. I know this is a very grey area and my first response was no since the Xray would not be considered a unique test, however the interpretation would not be billed by my providers so I can see why they would be asking this question. Of course the xray would go to an outside party for a final read, our providers would just be providing a preliminary read but again we would not be billing for that professional component. It seems by definition this scenario would be excluded as some part of the testing would be billed/reimbursed by our organization. I've tried looking into this with reputable sources and cannot find any solid evidence to confirm nor deny the assumptions so thought I would reach out for other coders opinions. Of course the providers are hard set on this as the unique test qualifier can definitely impact the overall MDM.
Any thoughts/opinions/supporting evidence would be greatly appreciated.