Wiki Clarification on reviewing tests

[Kcronin1122]

Can someone help me clarify when a physician reviews tests.

Is this based on a department or provider?
Say a patient was seen in the clinic and the provider reviewed test (ekg, echo, cath) that was done in the hospital can we count this as test reviewed for E/m’s? If another provider from the same specialty is billing for these can we count this as test reviewed if it’s different dos?

 

[csperoni]

For coding, it does not need to be the same physician. Anyone in the same group with the same specialty are all counted as though they are the same physician.
Don't forget, a test cannot be counted for review if you (meaning any provider in the group with the same specialty) ordered it. It is counted at the order and review is included. You also cannot count the order or the review if you (again, any provider in the group with same specialty) performed the professional component of the test.
Examples:
1) Dr. C. (cardio) orders a CT. Radiologist Dr. R performs and interprets the test. Patient returns to Dr. D. (also cardio, Dr. C's partner) to discuss results and next steps.
You count the order by Dr. C only.
2) Same example as above except Dr. D. is a cardiologist in a different group.
You count the order by Dr. C. You count the review by Dr. D.
3) Same example as above except Dr. D is credentialed as and practicing in electrophysiology.
You count the order by Dr. C. You may also count the review by Dr. D due to different specialty credentialing.
Please note - there are some "informal" specialties that physicians may practice but are both credentialed as same specialty. You may not count the review in that case.
4) Dr. C (cardio) orders EKG. It is performed in his office the following day, and Dr. D interprets the EKG and discusses results with patient.
You count no data. Practice is paid for the work of ordering and reviewing EKG by billing the EKG itself.

https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

 

[natashalage]

Dear Christine, thank you very much for your response as always. I need some clarification please and I will greatly appreciate your help because I believe I don’t count Data correctly. Is that correct that if physician #2 reviewed the test that was done by another physician #1 (They belong to the same specialty) then I cannot count this data review? Example, I code for optometrists. Optometrist #1 performed the OCT 99134 test, billed for it, reviewed it etc. Today, optometrist #2 reviewed the test as a part of patient’s multiple conditions. May I give MD#2 1 point for reviewing the data -OCT since he didn’t order this test nor bill nor reviewed it previously? It is his first time seeing this OCT data. I could not find this explanation in the attached file. Thank you very much.

 

[csperoni]

Dear Christine, thank you very much for your response as always. I need some clarification please and I will greatly appreciate your help because I believe I don’t count Data correctly. Is that correct that if physician #2 reviewed the test that was done by another physician #1 (They belong to the same specialty) then I cannot count this data review? Example, I code for optometrists. Optometrist #1 performed the OCT 99134 test, billed for it, reviewed it etc. Today, optometrist #2 reviewed the test as a part of patient’s multiple conditions. May I give MD#2 1 point for reviewing the data -OCT since he didn’t order this test nor bill nor reviewed it previously? It is his first time seeing this OCT data. I could not find this explanation in the attached file. Thank you very much.

Clinician #2 of the same group and same specialty cannot count reviewing a test that Clinician #1 performed. Your practice was already paid for the work of reviewing the data.
Similarly, if a year later, a clinician re-reviews a previous test, you would not count it again.
I'm assuming you have a typo and mean 92134. That CPT has a professional component, so you would count neither the order nor the review and the work is reimbursed by CPT 92134 itself. Counting the order or review as part of the E/M service would be counting it twice.
If Clinican #2 was seeing a patient that a provider of a different group/specialty performed, Clinician #2 can be credited with review.
I hope that made it clearer.

 

[natashalage]

Thank you, Christine, for your response. I see what you are saying... I am afraid I didn't count the data correctly and unfortunately, I could not find clarification in the attached file https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf. Therefore, I will confirm with our educator and be back. I love AAPC Forums! It's a platform where we learn, re-enforce our knowledge that are so important in our coding field! Thank you to all participants that are willing to share their knowledge and be the Best coder
I just confirmed that I cannot count Data review for MD2 when "it was already billed by a provider in the same specialty". wow, I was wrong. Coding is a lifelong- learning journey. Thank you, Christine, for always being nearby to answer our questions!