Wiki MDM - Data: Test

KoBee

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Just want to make sure I understand when a provider gets credit for test.

If a provider orders an x-ray and reads the results that same day, I understand he only gets credit for the ordering.

But if he orders the x-ray when sees patient and reads the results the next following visit he sees the patient, does he get credit for reviewing results the next time he sees the patient?

5/1/21 - order xray
5/6/21 - review of xray

I got a bit confused as I read some are saying no and some say yes, help please.
 
The review is included in the order, so the provider doesn't get credit for a separate review even if it's done at a subsequent visit.
But I have another question - If a provider orders an x-ray of the ankle on 5/1 and also places a separate ankle x-ray order on 5/1 to be done on 5/6, does this count as 2 unique tests? I was thinking yes. "X-ray today. Follow up in 2 weeks with pre-clinic x-rays."
 
The review is included in the order, so the provider doesn't get credit for a separate review even if it's done at a subsequent visit.
But I have another question - If a provider orders an x-ray of the ankle on 5/1 and also places a separate ankle x-ray order on 5/1 to be done on 5/6, does this count as 2 unique tests? I was thinking yes. "X-ray today. Follow up in 2 weeks with pre-clinic x-rays."
Yes, each order is a uniques CPT code. When provider gets credit at visit date for ordering, interpretation is included. The interpretation on second visit counts towards reviewed test ONLY if not counted as ordered test on first visit.
 
Can anyone help me make sure I'm counting my unique test correctly.

If a provider orders CBC, Lipid Panel, Urine test .. all 3 unique test but do you group them as one and fall under " ordering of each unique test " .. so then you don't meet a low for Data? or can I considered them a combination of 2 to meet a low under Data?

Hope I make sense :/
 
You count each CPT code without overlapping elements as a unique order.
From AMA 2021 outpatient E/M guide:
Test: Tests are imaging, laboratory, psychometric, or physiologic data. A clinical laboratory panel (eg, basic metabolic panel [80047]) is a single test. The differentiation between single or multiple unique tests is defined in accordance with the CPT code set. For the purposes of data reviewed and analyzed, pulse oximetry is not a test.
Unique: A unique test is defined by the CPT code set. When multiple results of the same unique test (eg, serial blood glucose values) are compared during an E/M service, count it as one unique test. Tests that have overlapping elements are not unique, even if they are identified with distinct CPT codes. For example, a CBC with differential would incorporate the set of hemoglobin, CBC without differential, and platelet count. A unique source is defined as a physician or qualified heath care professional in a distinct group or different specialty or subspecialty, or a unique entity. Review of all materials from any unique source counts as one element toward MDM.

You have 3 unique test orders here - moderate data.
This is different than pre-2021 or inpatient E/M when you would count that as 1 data point for review/order lab test.

I strongly suggest everyone read, re-read, re-read then re-read the AMA 2021 outpatient E/M guide. If you have a question, read it again. I still refer to it regularly and it really does clear up most confusion.
 
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