Wiki Can a provider charge for lab reviews that were ordered during an E/M visit?

[carrots13]

My providers like to call their patients about the lab results which is great. I have conflicting information about the charge for a call. The labs were ordered as part of the e/m from a week or two ago. The labs were used to establish the level of service. Then the review happens and at times there is no treatment changes, referrals or other intervention. Can a phone charge still occur? I am conflicted if this is considered double dipping.

 

[melhydock]

I believe that you would not charge the phone call based on the following from Coding Intel's site:

"Question: If I order an MRI at a visit on Sept. 20, and review it with the patient at a follow up visit on Sept 27, do I count the order on the 20th and the review on the 27th? I didn’t bill for the MRI or the interpretation.

Answer: No, count it once, at the order. CPT says,

“Ordering a test is included in the category of test result(s) and the review of the test result is part of the encounter and not a subsequent encounter.”
And, from the CPT Assistant, (AMA publication) November, 2020, page 5: “It is assumed that the physician or other QHP would review the results of the test ordered; therefore, the physician or other QHP would not receive dual credit toward MDM for service-level selection for both ordering and reviewing the test.”

The AMA is consistent in this instruction. If you order a diagnostic test, say a CBC at a patient visit, reviewing the results that day, or, a day later, or at the subsequent visit, it 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."

Here is the link to the entire article: FAQ: Scoring elements in the E/M guidelines

 

[jkyles]

Hi there, you're correct that it would be double-dipping. Giving a patient their test results is included in the pay for the E/M visit.

As for billing a call, I recommend reviewing the instructions for reporting telephone visits with your providers. The call must be initiated by the patient (and the provider can't force the patient to call by withholding their test results). In addition, there are timing requirements for when a call can be billed separately.

 

[davidinasheville]

I would bill for a telephone vist to discuss results with a patient if it meets the requirements. Can't bill for telephone if within 7 days of an encounter on the same subject. There is no need for the patient to initiate the contact (unlike for the "virtual visit"). Telehealth is okay anytime.

Telephone E/M services are provided to a patient, parent, or guardian and do not originate from a related E/M service within the previous seven days and do not lead to an E/M service or procedure within the next 24 hours or soonest available appointment.

Note exceptions:

Telephone E/M services should not be reported when the time spent on the telephone is captured in other services reported, such as:

• if CPT codes 99421-99423 have been reported by the same physician in the previous seven days for the same problem,
• when CPT codes 99339-99340 and 99374-99380 are used for the same call,
• during the same month with CPT codes 99487 and 99489, and
• when performed during the same service period at CPT codes 99495-99496.