Wiki E&M question on hearing tests if 2 are ordered do we count as 2 points under Data Review?

[wynonna]

If MD orders 2 hearing tests with 2 different CPT codes, would this count as 2 points since each CPT code is uinque?
thank you my fellow coders.

 

[b.cobuzzi]

If the practice is billing out the audiology, the data cannot be counted. They are being paid for the hearing tests and so they can’t be paid for the “points” in data in MDM for ordering the audiology.

 

[Katie22c]

If the practice is billing out the audiology, the data cannot be counted. They are being paid for the hearing tests and so they can’t be paid for the “points” in data in MDM for ordering the audiology.

Do you know where I can find this information? I don’t see where it is referenced in the e&m audit tool.

 

[csperoni]

Not sure what audit tool you are using, but it is very clear in the AMA guidance that you may not count data points for a test you are billing. The guidance was updated to clarify you cannot count data points for test you are billing, provided there is an interpretation component.

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

"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."

For example, a rapid strep test has no interpretation built into the procedure code, so you may count it. If the hearing tests do have interpretation built into the value (I believe they all do but definitely not my wheelhouse), to count it again would be double dipping. The physician is being reimbursed for the work of ordering of the test in the payment for the test itself.

 

[jackjones62]

Per the AMA E/M 2021 Guidelines, page 3
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. 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 MDM.
The physician or other qualified health care professional may need to indicate that on the day a procedure
or service identified by a CPT code was performed, the patient’s condition required a significant
separately identifiable E/M service. The E/M service may be caused or prompted by the symptoms or
condition for which the procedure and/or service was provided. This circumstance may be reported by
adding modifier 25 to the appropriate level of E/M service. As such, different diagnoses are not required
for reporting of the procedure and the E/M services on the same date.