I work for orthopaedics and we have an on site MRI. If one of my docs orders an MRI, without knowing for certain where the MRI will take place, can I count that as an order for a unique test? The argument is that the patient/insurance may decide to go to an outside facility, in which case the MD would not know at the time of the order. I understand that we cannot include the review of the MRI on the visit after if we billed for the MRI. However, prior to any of that taking place, the MD has decided further imaging is needed to diagnose the condition. Or do we simply have to assume that every MRI is done in house and therefore we cannot count the order in the overall E/M from that initial visit?