Wiki PFTS and interpretations

[tworrock]

Hi all,

Our provider had a telehealth visit on 10/27/22 with the patient and put in the visit note in the f/u plan to review PFT. PFT order wasn't placed by our office until 11/21/22. The patient gets PFT done on 12/6/22 at the other facility. Provider interprets results on 12/9/22. No f/u appt scheduled at this time.

Typically, our provider interprets PFTs for the local hospital but they're not our patients. This one is and we ordered the test. So usually, I would bill the PFT code with professional component.

But since it was discussed at last visit, ordered a few days later, then pt got it a few weeks later, then ordering physician interpreted it a few days later, I'm not sure if it counts towards medical decision-making at the initial appointment... Since it wasn't actually ordered that same day?

So bill 94060-26, 94729-26, and 94726-26 all for the date the provider interpreted it, the date the MA actually physically sent over the fax lab order, the date of the original visit when the provider put in that they wanted it ordered, or the date of service the patient received the PFT?

Thank you!

 

[lgardner]

if your provider ordered the test, he/she cannot, also, count the review of the results.

per Noridian:
Q4. Can providers receive credit in MDM for reviewing a test if they don’t bill the professional component?
A4. If the provider’s organization neither ordered the test nor billed for the diagnostic test, then the provider may receive credit in MDM. If the diagnostic service is rendered in-house, the provider may not receive credit for the order and review. If it is a service that allows the professional component to be separately billed, the provider who performed the professional component may submit the professional component for payment. If the test was not billed by the provider’s organization, the credit for the review would normally be included in the credit for the order. When a test or procedure is explained or planned and the beneficiary decides to refuse the test or service, the treatment decision can receive decision making credit when included in the documentation.

 

[tworrock]

if your provider ordered the test, he/she cannot, also, count the review of the results.

per Noridian:
Q4. Can providers receive credit in MDM for reviewing a test if they don’t bill the professional component?
A4. If the provider’s organization neither ordered the test nor billed for the diagnostic test, then the provider may receive credit in MDM. If the diagnostic service is rendered in-house, the provider may not receive credit for the order and review. If it is a service that allows the professional component to be separately billed, the provider who performed the professional component may submit the professional component for payment. If the test was not billed by the provider’s organization, the credit for the review would normally be included in the credit for the order. When a test or procedure is explained or planned and the beneficiary decides to refuse the test or service, the treatment decision can receive decision making credit when included in the documentation.

Thank you! So where it says, "If it is a service that allows the professional component to be separately billed, the provider who performed the professional component may submit the professional component for payment," would that not allow it? That's the only line throwing me off.

 

[lgardner]

if you submit the professional component for payment, then it cannot be counted towards MDM (or time, for that matter).

 

[tworrock]

if you submit the professional component for payment, then it cannot be counted towards MDM (or time, for that matter).

I see. So if the patient has a follow-up appointment to review the results with the ordering provider (who also interpreted it), can we bill for that follow-up visit? Or is that not allowed because the interpretation of results is included in the MDM for that original telehealth appt where the provider ordered it?

 

[lgardner]

I see. So if the patient has a follow-up appointment to review the results with the ordering provider (who also interpreted it), can we bill for that follow-up visit? Or is that not allowed because the interpretation of results is included in the MDM for that original telehealth appt where the provider ordered it?

if there is a follow-up visit, you can bill whatever level E/M that the documentation supports.

BUT, you cannot count the PFT, at all, for MDM Data column.
either you were paid for the service OR the original order was counted towards MDM at the time of the order.

 

[tworrock]

if there is a follow-up visit, you can bill whatever level E/M that the documentation supports.

BUT, you cannot count the PFT, at all, for MDM Data column.
either you were paid for the service OR the original order was counted towards MDM at the time of the order.

So the payment for the interpretation done on 12/9/22 is technically already included in the payment for the telehealth visit on 10/27/22 because that's when it was ordered & used as a factor in medical decision making?

If the follow-up visit is literally only to go over the results of that PFT and no other problems/topics addressed, would we then need to bill based on time spent reviewing the results with patient?

Thank you for your help!

 

[lgardner]

the original DOS 10/27/22, should not have counted the order of the PFT towards MDM. since the provider is getting paid for the professional component.
However, if the provider wasn't going to get paid for the professional component (or any part of the PFT), then it would have been correct to count the order towards MDM.

if there is a follow-up to go over the results, there can still be an E/M, but you will not be able to count the PFT towards MDM.

Remember that even when using time to determine the level of an E/M, medical necessity must still be there.
so, it wouldn't be likely that a 99214 would be supported, BUT might be able to bill a 99212 (depending on documentation) with MDM OR time.

 

[tworrock]

the original DOS 10/27/22, should not have counted the order of the PFT towards MDM. since the provider is getting paid for the professional component.
However, if the provider wasn't going to get paid for the professional component (or any part of the PFT), then it would have been correct to count the order towards MDM.

if there is a follow-up to go over the results, there can still be an E/M, but you will not be able to count the PFT towards MDM.

Remember that even when using time to determine the level of an E/M, medical necessity must still be there.
so, it wouldn't be likely that a 99214 would be supported, BUT might be able to bill a 99212 (depending on documentation) with MDM OR time.

Okay, so telehealth appt on 10/27/22 where it was ordered is fine to leave as is.

So bill 94060-26, 94729-26, and 94726-26 all for the date the provider interpreted it, the date the MA actually physically sent over the fax lab order, the date of the original DOS when the provider put in that they wanted it ordered, or the date of service the patient received the PFT?

 

[lgardner]

the day that the MA, actually, entered the order, is irrelevant (in this situation). the order would have counted on the date the provider documented his order.