Wiki Test order/reviewed and interpretation of test help!!!!!

[Karalea88]

I have a provider that is questioning the credit for test order and/or reviewed and interpretation of test. I will provide a scenarios.

1. He sees patient and will have patient return to office in 1 year with EKG. He does not count the order of EKG with this visit. When patient follows up in 1 year he then counts the EKG results for review. Can he receive credit for review at follow up appointment since he did not receive credit for order at previous visit?

2. For all EKGs, ECHOs, Stress test ( office bills for procedure) he wants to receive credit for independent interpretation of test. Can he still receive credit for interpretation once he does the interpretation /follow up with patient?

Any feedback is appreciated!!!

 

[csperoni]

1) If you are performing EKG in house, you cannot count either the order or the review. There is a built in component to the EKG value for the order/review. You are already being compensated by the EKG itself. Only tests that have no professional component can be counted toward data when done in house. If the EKG is being done elsewhere, you may count the order OR review. I recall seeing somewhere to count the order, and then the review is included.
2) The same provider (or group with same specialty) cannot bill for the complete test and then also for an independent interpretation. You also cannot bill for an independent interpretation of a test you did previously.

Both of these scenarios sound like you are trying to get payment twice for the same work, which is not permitted.
From AMA's 2021 Outpatient Guidelines: https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

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.

Independent interpretation: The interpretation of a test for which there is a CPT code and an interpretation or report is customary. This does not apply when the physician or other qualified health care professional is reporting the service or has previously reported the service for the patient. A form of interpretation should be documented but need not conform to the usual standards of a complete report for the test.

 

[Karalea88]

Thank you for helping clear this up!