Question 2021 MDM Guidelines

awagner81

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The new MDM grid under "Complexity of Data" Category 1 lists Ordering of each unique test, Review of the result of each unique test. In my practice we order x-rays and interpret the x-rays then bill the x-ray. Does this mean that we can only get credit for the order of the x-ray and NOT the review (interpretation) since we bill for the X-ray ? I am confused because it only states "not separately reported" under Cat 2 & 3 and not under Cat 1 for each level .
 

TinaBeatie20

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The new MDM grid under "Complexity of Data" Category 1 lists Ordering of each unique test, Review of the result of each unique test. In my practice we order x-rays and interpret the x-rays then bill the x-ray. Does this mean that we can only get credit for the order of the x-ray and NOT the review (interpretation) since we bill for the X-ray ? I am confused because it only states "not separately reported" under Cat 2 & 3 and not under Cat 1 for each level .
You cannot get credit for the review if you have already billed for it . This is double dipping. The "not separately reported" Categories 2 & 3 is referring to Assessments Requiring Independent Historians and Discussion of Management of Test Interpretation and not the test itself. The test interpretation in Category 3 involves tests that the other provider has already billed out so that is why they specify "not separately reported."In regards to the tests themselves, because it is being separately reported by your practice you cannot get credit for the review also.
 
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