Oncology & Hematology Coding Alert

Question: One of the physicians in our office ordered a CT scan for a patient on 7/1. The scan was then interpreted on 8/15 by a different physician who also practices in our office. Does the CT count for 1 point on 7/1 when it was ordered? Or does it count for Category 2 “Independent Interpretation of tests” on 8/15 when it was interpreted?

AAPC Forum Participant

Answer: First, you are asking whether you can count the interpretation of a test separately from the ordering of that test when a physician from the same practice as the ordering physician is interpreting the test.

The answer to this question is “no.” The test analysis would only be regarded as separate from the ordering of that test if the physician was external, meaning “an external physician or other qualified health care professional who is not in the same group practice or is of a different specialty or subspecialty,” per CPT^®. Therefore, CPT^® would regard both test and analysis in this situation as having been conducted by the same physician.

CPT^® guidelines are very straightforward regarding your second question. “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,” per CPT^®. In other words, you would count the test on the 7/1 date of service.