Labs done the day of visit

[KaylaRieken]

If a patient gets a UA done during today's visit and your doctor reviews it, can that count for 1 point towards lab review even if we bill for the UA? (for 2020 or 2021) or is that considered double dipping?

 

[thomas7331]

Clinical lab tests do not have a professional component, so there would be no overlap between the professional work involved in the MDM portion of the E&M service with the charge for the lab test itself.

 

[KaylaRieken]

So for the 2021 guidelines, can you count the UA towards reviewing the lab under category 1 even if you are billing for the UA? It is not counting it towards our points in our EMR so I am a little confused.

 

[trarut]

It was described to me that if you are billing for the lab test, radiology exam, etc, it does not get counted.

 

[thomas7331]

The guidelines for data state "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". In other words, they are saying that if the provider is reporting the interpretation separately then it would not count toward the MDM. It does not say that if the provider's office or facility is billing the technical component that it would not count toward the data in the MDM.

So, as I understand it, if the test has a professional component that the provider is reporting separately, such as the interpretation of an EKG being billing with 93010, then that provider cannot count the EKG in the MDM. But interpretation of clinical lab tests is never reported separately (there is no CPT code for a provider to bill for interpreting a UA). It would always be appropriate to count the ordering or interpretation of labs as part of MDM, regardless of whether the lab is billed by the office or billed by an outside lab.