Pediatric Coding Alert

Answer: This is a common source of confusion. Simply put, the review of the test does count toward MDM, but it’s included in the order and therefore cannot be counted as separate from that order. Using the pediatrician’s review of the test toward the data element for MDM is considered double-dipping.

CPT^® guidelines say that the test’s review “is not counted as a data element ordered, reviewed, analyzed, or independently interpreted for the purposes of determining the level of MDM,” because the physician/QHP work for that test has already been captured in a separately reported CPT^® code.

The one exception to this rule is when an outside source orders and bills for the test, but your PCP reviews it. In this case you can count the review as a data point for your levelling calculations.