Answering Your Questions about Lab Tests
July 3, 2023
In this week’s Coffee & Coding, we tackle an intriguing question posed by a reader—a question that I’m sure many of us have contemplated at some point:
Can lab and radiological tests that are ordered and subsequently read count toward the data section in MDM (Medical Decision-Making)?
The straightforward response is No.
However, let’s explore the topic in more detail with insights from the American Academy of Professional Coders (AAPC):
“According to the American Medical Association (AMA), the ordering and actual performance and/or interpretations of diagnostic tests/studies during a patient encounter are not included in determining the level 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.”
What if the other physician who ordered the labs and reports separately is a colleague in the same medical specialty as you?
According to the American Academy of Family Physicians (AAFP):
“You may count review of data separately ONLY if the tests were ordered by an external physician—one who is not in the same group practice or is in a different specialty (e.g., an Emergency Department physician orders a chest x-ray and labs that are then reviewed by a family physician during a follow-up visit).”
“It is assumed that the physician or other qualified health professional (QHP) would review the results of the test ordered; therefore, the physician or other QHP would not receive dual credit toward MDM for service-level selection for both ordering and reviewing the test.”
Got a question about E/M coding? We’d love to hear from you.
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CPC, CFPC, CEMC
Senior Manager, Regulatory and Coding Compliance