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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.
 
amyjph said:
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.
Click to expand...
thank you so much! I'm not sure how people keep track of if they've already counted a lab as ordered at a previous visit that was reviewed in a following visit so they don't count it twice. I would have to put tons of billing alerts on patients all the time. so given that information you gave me it seems like it makes since to just count labs when they are ordered and know that you already basically counted them at a previous visit when ordered. But what if a higher MDM is already met with other components and then you want to save the review for future visit to help it toward that future mdm so that you could potentially get a high mdm at the following visit then i guess you would just have to be really thorough with keeping track on each patient that you do that with which does seem exhausting lol
 
It has to be counted when ordered. You can't "save it" for later to bump up a later visit. Go back to the AMA CPT link again and read it (pg 6). https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf 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.

7. Can we count the order and the review of the testing separately to meet category 1 requirements for a moderate level of service?
The order and review of the test is only counted once. The AMA states in the definition of Analyzed states in part “Tests ordered are presumed to be analyzed when the results are reported. Therefore, when they are ordered during an encounter, they are counted in that encounter.”


Don't get squirrely! LoL ;)
 
amyjph said:
It has to be counted when ordered. You can't "save it" for later to bump up a later visit. Go back to the AMA CPT link again and read it (pg 6). https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf 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.

7. Can we count the order and the review of the testing separately to meet category 1 requirements for a moderate level of service?
The order and review of the test is only counted once. The AMA states in the definition of Analyzed states in part “Tests ordered are presumed to be analyzed when the results are reported. Therefore, when they are ordered during an encounter, they are counted in that encounter.”


Don't get squirrely! LoL ;)
Click to expand...
hahaha! i like your "don't get squirrely!" lol! sometimes i def overthink and thought maybe if i don't count it at order and don't separately bill for it i could save it for later as the review lol! but i think it would also get way to messy to keep track of that even if that was allowed! all your information was great! in the 2nd link there is this in the Q&A and this has me thrown i a bit, I'm clearing missing something because it sounds contradictory. do you think you could explain this one to me?
I attached it.
Thank you so much!
 

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You're welcome. I remember what it was like trying to figure all of this out without help sometimes when starting out (or even now.) Hah.

That is an odd one for sure. What I believe that means is, does a provider get "extra credit" if they are ordering tests from more than one service type (category). For example, would it bump up the credit or complexity if they order radiology, lab, and some other unique test rather than just 3 things from the lab section? The answer is no.

The number of data points is based on ordering separate, distinct tests — not on whether those tests come from different departments or service categories. Spreading your orders across labs, radiology, etc. gives you no special advantage.
 
amyjph said:
You're welcome. I remember what it was like trying to figure all of this out without help sometimes when starting out (or even now.) Hah.

That is an odd one for sure. What I believe that means is, does a provider get "extra credit" if they are ordering tests from more than one service type (category). For example, would it bump up the credit or complexity if they order radiology, lab, and some other unique test rather than just 3 things from the lab section? The answer is no.

The number of data points is based on ordering separate, distinct tests — not on whether those tests come from different departments or service categories. Spreading your orders across labs, radiology, etc. gives you no special advantage.
Click to expand...
awww thank you so much!!! i appreciate your sympathies for trying to figure it all all out and you sharing information! some people are more guarded than others with willing to share information. If you did order tests from different departments you could count that though right? there's nothing against that? as long as you are not billing separately for the professional component you can count that towards and order of a test?

thanks tons!
 
Korbc said:
awww thank you so much!!! i appreciate your sympathies for trying to figure it all all out and you sharing information! some people are more guarded than others with willing to share information. If you did order tests from different departments you could count that though right? there's nothing against that? as long as you are not billing separately for the professional component you can count that towards and order of a test?

thanks tons!
Click to expand...
Each test counts, correct. Doesn't matter where it was categorized.

Example:
2 unique lab orders + 1 X-Ray order (not separately reported) + 1 MRI order (not separately reported) = 4.
 
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