Wiki Question on Data elements for standing order and review later

[carrots13]

Our primary care has made standing orders for some patient labs, i.e., diabetic follow-up. There is confusion about the data elements for E/M visits to review the lab done on standing orders and create a plan going forward. Can the data point be counted as a review of results at the office visit for follow-up after labs were done based on the standing order? I feel this is double dipping as the standing order was created at an E/M visit, but I have been told it is not. Can anyone clarify and point me toward a clear definition of standing orders and using them as data elements for MDM? Thank you!

 

[csperoni]

This is addressed in the AMA E&M guidelines:
Analyzed: The process of using the data as part of the MDM. The data element itself may not be subject to analysis (eg, glucose), but it is instead included in the thought processes for diagnosis, evaluation, or treatment. Tests ordered are presumed to be analyzed when the results are reported. Therefore, when they are ordered during an encounter, they are counted in that encounter. Tests that are ordered outside of an encounter may be counted in the encounter in which they are analyzed. In the case of a recurring order, each new result may be counted in the encounter in which it is analyzed. For example, an encounter that includes an order for monthly prothrombin times would count for one prothrombin time ordered and reviewed. Additional future results, if analyzed in a subsequent encounter, may be counted as a single test in that subsequent encounter. Any service for which the professional component is separately reported by the physician or other qualified health care professional reporting the E/M services is not counted as a data element ordered, reviewed, analyzed, or independently interpreted for the purposes of determining the level of MDM.
A standing order would be just like the recurring order example given.
If the standing order is done during an encounter, it is counted as one ordered/reviewed at that encounter. After the first test is done, additional testing may be counted as reviewed during a subsequent encounter.
If the standing order is done outside an encounter, it may be counted at the encounter it is reviewed.