We order our own testing in office. Examples rapid strep , flu, cbc ect. Our records show were the test were ordered and also show where they are reviewed. When looking under the column amount and or complexity of data to be reviewed since our dr orders the test then as well reviews it would that qualify as >order of each unique test and >review of the result(s) from each unique source? I apologize i am over reading everything and now completely confused.
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Wiki MDM Pediatrics and office labs
- Thread starter ssharp
- Start date
rthomas@impcna.com
Guru
From the webinars I have watched, you can not count it as reviewed if you are billing the test, you can only count as ordered.
Ok! If we order multiple test does each one count as a unique ordered test? For example if I am looking at moderate data being reviewed * i DO NOT have a properly documented assessment of an independent historian but * we ordered 3 separate labs: CBC, Flu and Mono. Would this count as any combination of 3 to qualify for Moderate data?
rthomas@impcna.com
Guru
I am trying to find clarity to that same question because we all have heard different interpretations regarding this question.
rthomas@impcna.com
Guru
I had posted this question earlier on the forum and I got this response.
There is some confusion regarding the amount & complexity of date reviewed & analyzed. The question I have is in regards to category 1, if a provider orders 2 tests, an EKG and Spirometry for example, does this count as meeting the requirement for limited data or does the provider have to order tests and complete one of the other 2 items for it to count as limited?
For data, Category 1, if you order 2 unique tests that you are not billing for, that counts as limited data (level 3).
For limited, must meet 1 of 2 categories, and category 1 states "ANY combination of 2"
Limited (Must meet the requirements of at least 1 of the 2 categories)
Category 1: Tests and documents. Any combination of 2 from the following:
•Review of prior external note(s) from each unique source*;
•review of the result(s) of each unique test*;
•ordering of each unique test*
or
Category 2: Assessment requiring an independent historian(s)(For the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high
Alternately, for extensive - extensive states must meet 2 of 3 categories, so no matter how many tests you order or review, unless you are also doing an independent interpretation or discussing interpretation with external HCP, you cannot meet extensive data.
Extensive (Must meet the requirements of at least 2 out of 3 categories)
Category 1: Tests, documents, or independent historian(s). Any combination of 3 from the following:
•Review of prior external note(s) from each unique source*;
•Review of the result(s) of each unique test*;
•Ordering of each unique test*;
•Assessment requiring an independent historian(s)
or
Category 2: Independent interpretation of tests
•Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported);
or
Category 3: Discussion of management or test interpretation
•Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)
There is some confusion regarding the amount & complexity of date reviewed & analyzed. The question I have is in regards to category 1, if a provider orders 2 tests, an EKG and Spirometry for example, does this count as meeting the requirement for limited data or does the provider have to order tests and complete one of the other 2 items for it to count as limited?
For data, Category 1, if you order 2 unique tests that you are not billing for, that counts as limited data (level 3).
For limited, must meet 1 of 2 categories, and category 1 states "ANY combination of 2"
Limited (Must meet the requirements of at least 1 of the 2 categories)
Category 1: Tests and documents. Any combination of 2 from the following:
•Review of prior external note(s) from each unique source*;
•review of the result(s) of each unique test*;
•ordering of each unique test*
or
Category 2: Assessment requiring an independent historian(s)(For the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high
Alternately, for extensive - extensive states must meet 2 of 3 categories, so no matter how many tests you order or review, unless you are also doing an independent interpretation or discussing interpretation with external HCP, you cannot meet extensive data.
Extensive (Must meet the requirements of at least 2 out of 3 categories)
Category 1: Tests, documents, or independent historian(s). Any combination of 3 from the following:
•Review of prior external note(s) from each unique source*;
•Review of the result(s) of each unique test*;
•Ordering of each unique test*;
•Assessment requiring an independent historian(s)
or
Category 2: Independent interpretation of tests
•Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported);
or
Category 3: Discussion of management or test interpretation
•Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)
AmandaBriggs
Expert
I agree with the above. You may also want to check with your MAC for guidance. My MAC, Noridian, does not allow you to count either the order or the review if you are performing and billing the test. This guidance is more restrictive than other guidance we have received.
Thank you i am going to do some research and see what i can find. We are primary commercial and some medicaid plans no medicare in pediatrics but am I am correct that most follow the MAC Guidelines?