Wiki MDM And Orders

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jamiepeters

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If a provider orders a test such as MRI (that we are not billing for) is it included In the MDM at this time? If it is included in MDM when ordered can you also include it in MDM when the patient returns for review of the results in a subsequent encounter?

Email response regarding the same question. I am finding other info through my own research so I am not sure what is correct and wanted to find out what everyone else is doing in this situation.
The category for data per the AMA is based on date of service, when leveling the E/M. So my understanding is as follows: Date of Service a: order was made (yes it can be counted). if results will take of couple of days patient returns Date of Service b to discuss those results and further treatment protocol, then yes it can be counted again. It remains a date of service element; point of care.
 
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These new E&M guidelines were intended to simplify things, but from questions such as these that you can see all of the forum right now, they are actually creating a lot of confusion instead.

I have also been hearing people say they're 'being told' that you can only count either the order or the interpretation of a test toward MDM. However, I'm not sure how this could ever be done in practice or ever be enforced in audits. As the OP correctly points out, E&M coding is always done based on the documentation for a particular encounter on a specific date of service. It's a basic principle that coders and auditors do not draw information from past records to determine how to code that encounter.

So imagine a situation where you are coding that follow-up visit and trying to decide whether or not you can count the interpretation - you would need to go back to the encounter where the test was ordered, and re-code that encounter to try to figure out if the order was counted in the MDM before you could decide whether or not to count if for your encounter. So you'd be saying that a coder is actually required to code two encounters in order be able to accurate assign a code for the one. Or let's say you were a payer auditor reviewing provider records to validate whether or not that encounter was coded correctly - you wouldn't even be able to validate the coding of many encounters without actually requesting additional records to see how previous encounters were coded. This wouldn't make sense at all. If the guidelines are truly meant to reduce administrative costs they would not being requiring the extra work to calculate MDM that this would involve.

I think it is just common sense that each encounter has to be coded on its own merits. Whoever is giving out this information that it is 'double-dipping' to count both the order and the review of the results, done at two separate encounters, toward the MDM of each of those encounters perhaps has not thoroughly considered the implications of what they are saying. Hopefully we'll see some clarifications published on these guidelines soon to clear up some of this confusion.
 
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I've attended many Webinar's trying to understand the new rules.
My take away is this:
  1. If a test is ordered on the DOS for which you do not bill professional component, then it is 1 point towards MDM. The review of that test is included within that 1 point. You cannot get credit for both ordering and reviewing the same test. This is considered double dipping.
  2. If a test is ordered by your provider after the DOS for which you do not bill professional component, or you are reviewing an outside test (test not ordered by your provider group), then it is 1 point towards MDM.
 
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Thomas7331 I understand what you are saying and agree however the confusion comes in when reading info like this from the AMA which I was told have the correct rules and should be following what they say.
See the highlighted section below. The title of the publication put out by AMA is:
CPT Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes.

1611853634682.png
 
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I totally agree with Thomas on this situation. You should not have to code multiple visits to determine if the review was already counted. Unfortunately, the AMA guidance specifically states if you counted data for the order, you don't count the data for review.
Scenario 1. See the patient Monday the 1st, order a CT, then patient comes Friday the 5th to discuss abnormal results. You get ordering credit on Monday only. No review credit on Friday.
Scenario 2. See the patient Monday the 1st, don't order a test. On Wednesday the 3rd, pt calls and states symptoms are worse - you now order a CT without seeing patient again. Pt returns Friday the 5th. Since you didn't order the test on the 1st and did not get credit then, on Friday's visit, you are be able to count the review.
If you do not also re-code the previous encounter, you do not KNOW whether or not you can count the review.
This needs to be straightened out ASAP.
 
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