Wiki 2021 MDM on ordering test and return to review results

[Christal]

With the new 2021 MDM guidelines on ordering test can our office order like a CXR, CT scans, or lab work and count toward MDM then when they come in for follow up to review the results count towards test reviewed? We send the patient out for imaging and send labs off to be ran. We do not bill the CPT codes for this.

 

[smihm]

Here is an explanation I have on this topic form Codingintel.com

The AMA is consistent in this instruction. If you order a diagnostic test, say a CBC at a patient visit, reviewing the results a day later is part of the order. When the patient returns to the office two weeks later, you do not get credit for reviewing the CBC results that you ordered. Count the data for the test once, at the encounter when it was ordered.

 

[Christal]

We do patch testing in our office. We apply the test on Monday and the patient comes back for readings in 48 hours, 96 hours, and a 7 day reading. Our MD goes over the results and we give education and print out on avoidance if there are any positive findings. We also send an email to the patient containing a safe list of products to use. Our nurse reads the test and renumbers the areas so the chemicals can match up to the sheet. Our billing bills the test on Monday then we bill nurse visit on the 48 hour and 96 hour visit (unless the MD sees them on the 96 hour) and then bill OV on 7 day reading because of all the education and information given with positive findings. If there is negative findings then the MD will look at different treatment plan or causes. With the new guidelines are we only allowed to bill for the test? There is a lot of work into these appointments and information/education given to the patients that I feel and E/M should be counted on the last visit. The test itself does not reimburse what the MD feels is acceptable.

 

[csperoni]

We do patch testing in our office. We apply the test on Monday and the patient comes back for readings in 48 hours, 96 hours, and a 7 day reading. Our MD goes over the results and we give education and print out on avoidance if there are any positive findings. We also send an email to the patient containing a safe list of products to use. Our nurse reads the test and renumbers the areas so the chemicals can match up to the sheet. Our billing bills the test on Monday then we bill nurse visit on the 48 hour and 96 hour visit (unless the MD sees them on the 96 hour) and then bill OV on 7 day reading because of all the education and information given with positive findings. If there is negative findings then the MD will look at different treatment plan or causes. With the new guidelines are we only allowed to bill for the test? There is a lot of work into these appointments and information/education given to the patients that I feel and E/M should be counted on the last visit. The test itself does not reimburse what the MD feels is acceptable.

The question/answers earlier address whether you count reviewing the test as an element of "amount of data" for MDM. Not whether or not you can bill for the E/M services you provide.
In your scenario, you are billing the test itself day 0. 99211 on day 2, 99211 on day 4, then MD visit on day 7. Since you already billed for the test, you cannot count reviewing the test on day 7 (or any other day) toward "Amount and/or Complexity of Data to be Reviewed and Analyzed" (middle column on AMA chart https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf). Counting reviewing the test you billed for would be double dipping. You can still bill for the visits at whatever the appropriate level is based on MDM or time.
I hope that helps better explain it to you.