Ordering Tests and Review of Tests

anne32

Networker
Messages
98
Best answers
0
If our provider ordered a lab and we are not billing for it, we would count a point towards Ordering of tests. Would we also count a point for Review of test for that same lab? I am confused when to use Review of Tests.
 

amcook31

New
Messages
5
Best answers
0
It was my understanding that no, since it was being counted for ordering. It would be similar to counting for something that is separately billable.
 

Bernadette10

Networker
Messages
91
Best answers
0
That's my understanding too, that the review is included in the order. Here's something I got from an auditor that has been helpful for me:
From a CPT coding perspective, in general, you may not receive MDM credit for level selection for a service or test that is being billed. The CPT 2021 E/M guidelines have the following instructions under the heading: “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 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 reported separately. 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 answers to your additional specific questions are as follows: You asked:
1) If a provider orders and interprets (and bills for) a diagnostic test or lab (e.g. visual field, A1C) on same day as visit – no credit in the MDM. This is correct. There would be no MDM credit for a test that was billed.
2) If a provider orders and interprets (and bills for) a diagnostic test or lab (e.g. visual field, A1C) on same day, and orders future diagnostic test or lab – 1 credit for future order in MDM. This is correct. The order includes the review so there would be no separate MDM credit for the review.
3) If a provider orders a future diagnostic test (e.g. visual field) on the same day as a visit (only E/M billed), we get 1 credit in MDM for the order even though that same provider will interpret the visual field (and bill for the interp.) at a later date. No. This is not correct. The review and interpretation are included in the order. If the service is billed, even at a later date, it cannot be used for MDM level selection.
4) If a provider orders a diagnostic test or lab (does not bill for the interpretation) and reviews the results at a future visit-1 credit in MDM for ordering the test at the initial visit and 1 credit for review of the results at the future visit. No. This is not correct. The order includes the review. The provider receives one MDM credit for the order and the review even if the review is performed at a subsequent visit.
5) If a provider documents and reviews an old test (but previously billed for this test) – no credit in the MDM. This is correct.
6) If a provider documents and reviews an old test that was billed by someone else – 1 credit in MDM. The answer depends upon whether the test was ordered by a physician or QHP from the practice. As an example, if another physician in the practice ordered the test and billed for it, the review would not be part of MDM selection. If the test was ordered by a physician from a different practice, this would be an independent interpretation of the results and could be used for MDM level selection.
 
Top