Practice Management Alert

Question: If I order labs for a patient and also interpret the results, does the time spent on interpretation count toward medical decision making (MDM)?

New Jersey Subscriber

Answer: Probably not. Medicare Administrative Contractor (MAC) NGS highlights the situations in which a physician can bill an evaluation and management (E/M) service for MDM in regard to a diagnostic test, and doesn’t mention situations in which physicians interpret tests they ordered.

NGS provides these guidelines for situations involving diagnostic tests ordered, performed, interpreted, and billed (emphasis original):

• >“>By a different provider, >the ordering provider may take credit for ordering the test or reviewing the results during the visit (e.g., chest X-ray, CPT 71046).
• “By his/her office or group, >then no credit may be allowed for the order or review in the MDM component of the visit. This is because reimbursement for the interpretation of the test is included in the fee for the diagnostic service (e.g., EKG, CPT 93000).
• “By his/her office or group, but does not require or include separate interpretation, >the ordering provider may take credit for ordering and reviewing the test during the visit (e.g., CBC, CPT^® 85025).”