Based on our local carrier, NHIC (and consultants working in New England), neither is correct. You would get only one point each for ordering and reviewing the lab and rad under your data review. Even though the description of that data point is "review or order", we've been advised to allow only one point when you order and subsequently review results. And you definitely cannot get the points if you are going to also bill the professional component for the interpretation and report. The two additional points for "independent visualization of image, tracing, or specimen" is only if you are reviewing someone else's ordered diagnostics. NHIC's E&M audit tool specifically says "not simply review of the paper copy report".
I wonder if other carriers have a different interpretation? This is a great example of how different consultants give us information that isn't clearly outlined in regulatory guidance, and also how payers and regions differ in their E&M guidelines. Gotta love it!
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join