Wiki changes for 2121

[avrodriguez]

1. Any specifically identifiable procedure or service (ie, identified with a specific CPT code) performed on the date of E/M services may be reported separately.
   The actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when reported separately. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The physician’s interpretation of the results of diagnostic tests/ studies (ie, professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended. If a test/study is independently interpreted in order to manage the patient as part of the E/M service, but is not separately reported, it is part of medical decision making.

Can someone explain this better, I do in-house labs ( flu strep Cmp UA etc ) can i count them towards my medical decision making if I order them and review them the same day of the visit?

what does it to report them separately ?

 

[thomas7331]

The wording here is very confusing, but as I understand it, if the physician personally performs a diagnostic procedure for which that same physician bills a CPT code, or performs a professional component for interpreting a test at the same encounter and for which the physician creates a report and submits a CPT code, then those cannot be counted toward the MDM.

However, there is no professional component for clinical lab tests, so a physician would never be separately reporting the interpretation of those tests. So I believe it would be appropriate to consider lab tests that are ordered and/or review during the encounter as part of the MDM. Clinical lab tests are technical services only - there is no overlap between the CPT codes billed for these with the professional work that is being billed in an E&M service. I believe that the 'diagnostic tests/studies' they are referring to in these instructions are just those which have a professional component, not clinical labs.