New E/M guidelines and labs

pedihc

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When explaining to my physicians that we cannot get credit for doing in house labs, ie; strep, UA, flu, RSV they do not agree?! I tried to explain because we are billing for the labs it is somewhat double dipping. Their response is, so we do not get credit for ordering in house labs but we get credit for ordering out of office labs. How about the review of those out of office labs, we never get to have credit for reviewing them because 9/10 times we do not see the patient back in the office we just call them with results. Can anyone give me some tips on how I can explain this to them in an easier way? And am I understanding it correctly? Thank you!
 

brucep

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You'll find the answers to your questions in the following thread: https://www.aapc.com/discuss/thread...-cat-2-ordering-unique-tests-for-labs.176711/

In particular, I'd direct you to Cindy Hughes' comment. "Laboratory test orders or results are counted whether performed in-house or sent out to a laboratory because these codes are valued only to include the cost of the test and not physician interpretation and report. A physician does not get credit for ordering or reviewing results of tests when reporting a code that includes interpretation and report (e.g., voiding cystourethrogram). "When the physician or other qualified health care professional is reporting a separate CPT code that includes interpretation and/or report, the interpretation and/or report should not count toward the MDM when selecting a level of office or other outpatient services."

Hope that helps.
 

smihm

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AMA made revisions to the guidelines on 03/09/21 - in house labs can now be counted - the revised guidelines are posted on the AMA website
 

csperoni

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https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf Below the changes are bold in blue
Services Reported Separately
Any specifically identifiable procedure or service (ie, identified with a specific CPT code) performed on the date of E/M services may be reported separately. The ordering and actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when the professional interpretation of those tests/studies is reported separately by the physician or other qualified health care professional reporting the E/M service. 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. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The physician’s interpretation of the results of diagnostic tests/studies (ie, professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended. 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 MDM. The physician or other qualified health care professional may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant separately identifiable E/M service. The E/M service may be caused or prompted by the symptoms or condition for which the procedure and/or service was provided. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. As such, different diagnoses are not required for reporting of the procedure and the E/M services on the same date.

The interpretation of these changes has been that if a test does not have a professional component (such as many in house lab tests like UA, strep, etc.), the change means you may count the ordering or review for data of MDM. "Tests that doe not require separate interpretation ..... may be counted as ordered or reviewed for selecting an MDM level."
 
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