Wiki Unique tests ordered for future labs

Create Wiki
T

talumb@yahoo.com

New
Messages
7
Location
Keizer, OR
Best answers
0
I am wondering how everyone is handling the unique tests ordered when a provider orders lab tests for a future visit? EX: Patient comes in for sprained ankle and provider tells them to take Tylenol and rest. 99213 Then at same visit in the A/P they add HTN with CMP, CBC, DM2 with A1C That is adding 3 labs that have nothing to do with what they are being seen for?
Do we count them? If I don't count now how would I know to count them at the future appointment?
 
If the clinician is noting their diagnosis, and ordering labs, then they are addressing the problems (in addition to the sprained ankle). It may not be why the patient initially presented, but it is being addressed.
I would actually code that 99214 with dx for sprained ankle, HTN & DM2.
Problems addressed: 1 acute uncomplicated injury and 2 stable chronic illness - level 4
Data: 3 unique tests ordered - level 4
Risk: low - level 3
If patient returns to discuss test results, you do not count data for reviewing the tests as provider already received credit for ordering.
 
csperoni said:
If the clinician is noting their diagnosis, and ordering labs, then they are addressing the problems (in addition to the sprained ankle). It may not be why the patient initially presented, but it is being addressed.
I would actually code that 99214 with dx for sprained ankle, HTN & DM2.
Problems addressed: 1 acute uncomplicated injury and 2 stable chronic illness - level 4
Data: 3 unique tests ordered - level 4
Risk: low - level 3
If patient returns to discuss test results, you do not count data for reviewing the tests as provider already received credit for ordering.
Click to expand...
Thank you! Do you have any resources defining "unique tests?" All of the research, lectures and webinars that I have attended, back up billing all three unique tests. There is one individual who believes we are still using code sets based on 70000, 80000, 90000 rather than CBC, CMP and A1C. I am trying to find concrete evidence one way or the other.
 
The 2021 changes for outpatient E/M changed this so that a unique test is a test defined by CPT.
So a CMP is 1 unique test (since 1 CPT that is a panel of several tests). A CBC is a separate unique test from CMP.

Test: Tests are imaging, laboratory, psychometric, or physiologic data. A clinical laboratory panel (eg, basic metabolic panel [80047]) is a single test. The differentiation between single or multiple unique tests is defined in accordance with the CPT code set.

page 25
Codes from the 70000, 80000 and 90000 series are still included in data. However, now a Unique test is one where they have their own CPT code, so a CBC and a UA are now considered two tests versus just one in the previous years.
A test with a panel of results, but one CPT code is still considered one test.
 
Last edited:
You must log in or register to reply here.
Top