MDM Data

[linton@bresnan.net]

I would like some input on counting MDM Data in the medical office setting as my co-workers have differing interpretations. We have some lab tests performed in the office, such as finger sticks, urine dips, quick strep, etc that is billed with it's own CPT code along with the E/M. Does a person count these lab orders part of the data towards the E/M level or since it's being billed by the provider would this be considered double dipping? Thank you for any help.

 

[AmandaBriggs]

Good afternoon. Here is what the AMA has to say about this scenario, "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."
https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

 

[linton@bresnan.net]

Thank you, Amanda. Yes, I found that information as well but wanted confirmation of my interpretation of that statement. I appreciate your quick response.

 

[vcastellanos@cosm.pro]

I am also trying to make sense of this section in the AMA Guidelines. The verbiage is just confusing to me. Is it saying that if we bill an x-ray with an E/M in our office, we cannot count the x-ray towards tests ordered in the MDM?

 

[AmandaBriggs]

That's correct. Your provider is billing for the x-ray interpretation, so they can't also get credit for it in the MDM section, as that would be double-dipping.