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Korbc

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Hey guys
i just wanted some extra clarification on data for moderate mdm for specifically category 1........... If 2 or 3 tests are ordered that just counts as meeting the one bullet point of "ordering of each unique test" right? I would still need to get one of the other bullet points in category 1 in order for me to meet cat 1. 2 or 3 tests by itself would not have met category 1 because "ordering of each unique test" is already plural and just because it's 2 or 3 tests doesn't mean the 2 or 3 of the components for cat 1 are met right?

i hope someone understands what i'm saying since mabye sometimes i word things weird!
thanks!
 
If you are looking at Moderate Data and using Category 1, it is any combination. So, you could meet it with ordering 3 unique tests.

Examples: 2 unique labs and one independent historian
2 unique labs, 1 XR
1 external note review, 1 lab, 1 historian
1 MRI, 2 unique labs
3 unique labs

Moderate
(Must meet the requirements of at least 1 out of 3 categories)
Category 1: Tests, documents, or independent historian(s)
• Any combination of 3 from the following:
• Review of prior external note(s) from each unique source*;
• Review of the result(s) of each unique test*;
• Ordering of each unique test*;
• Assessment requiring an independent historian(s)

● Tests, documents, orders, or independent historian(s). (Each unique test, order, or
document is counted to meet a threshold number.)
 
thank you so much! also i took a test for TCN and i think i deleted their guidelines for the exam unfortunately and they won't give them to me, but i think in there i saw that some specific simple labs can be billed 2 separate times, 1 for the order and 1 for the review of results. does anyone know of any labs that can be counted twice because I'm 99 percent positive i saw this for "simple labs" in their instructions

thanks!
 
amyjph said:
If you are looking at Moderate Data and using Category 1, it is any combination. So, you could meet it with ordering 3 unique tests.

Examples: 2 unique labs and one independent historian
2 unique labs, 1 XR
1 external note review, 1 lab, 1 historian
1 MRI, 2 unique labs
3 unique labs

Moderate
(Must meet the requirements of at least 1 out of 3 categories)
Category 1: Tests, documents, or independent historian(s)
• Any combination of 3 from the following:
• Review of prior external note(s) from each unique source*;
• Review of the result(s) of each unique test*;
• Ordering of each unique test*;
• Assessment requiring an independent historian(s)

● Tests, documents, orders, or independent historian(s). (Each unique test, order, or
document is counted to meet a threshold number.)
Click to expand...
such great info and thanks for the link. one more question after my previous response, i've read generally people wait for the review of the labs to count them instead of at the order? any specific reasons behind that preference that maybe I'm not aware of?
thanks!
 
You're welcome. I would suggest refreshing on the definitions: https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

You are thinking of this when it comes to "simple labs" or tests which are results only. You can't count them twice. (see the word OR) "may be counted as ordered or reviewed"
Services Reported Separately
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 ordering and 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 the professional interpretation of those tests/studies is reported separately by the physician or other qualified health care professional reporting the E/M service. Tests that do not require separate interpretation (eg, tests that are results only) and are analyzed as part of MDM do not count as an independent interpretation, but may be counted as ordered or reviewed for selecting an MDM
level. The 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 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.◄

You wouldn't have to wait for the review of a lab to count it as being ordered for the purposes of calculating MDM for E/M. There are times when the path report/lab result is needed for coding purposes otherwise, but not just for counting EM. POC testing would be resulted at the time like Strep, Flu, etc. So there would be no "waiting". Unless it was a lab which is sent outside but you would still get credit for the order.
 
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