Wiki Outpatient visit, provider ordered 3 tests (covid, strep, flu). For data elements does that count as moderate for Amount and/or Complexity of Data?

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mrockvoan

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Provider orders 3 unique tests, does this meet moderate for the amount and or complexity of data? It says 1 out of the 3 categories have to be met. I know the rules were set and then they were changed not long after they came out in 2021. Thanks in advance.
 
My example is we run flu, strep and covid on a patient coming in with cold sx. This would meet a 99214 based on documentation if they prescribe Rx, BUT, is it really medically necessary to bill a 99214 if it was straightforward and the patient is a healthy patient with no underlying conditions.
 
While medical necessity is an overarching criteria, I am assuming this patient was not "healthy" when presenting, otherwise why would the provider have ordered 3 tests and written a prescription?
If it was just a runny nose and you believe the provider was being overcautious in ordering/prescriptions, you could consider 99213 instead. My personal opinion is that as a coder, I am not qualified to determine how a provider should treat a patient. If I had a provider who was consistently ordering what appeared to be unnecessary testing or prescriptions, I would educate the provider about proper documentation of why these items were ordered and the severity of the problem. Maybe the note only says runny nose but in reality, patient also had a fever of 104 and dizziness.
 
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