Primary Care Coding Alert

Question: If our provider orders labs for anemia, and we get the lab results the following day, can this be considered additional workup or do the results have to come back on the same day?

Codify Subscriber

Answer: As the provider has ordered the lab test, you would regard this as additional workup no matter when the results come back.

Why? Simply put, when you examine the Diagnostic Procedure(s) Ordered column in the Table of Risk the Centers for Medicare and Medicaid Services (CMS) uses, such as the one found at  www.cms.gov/Outreach-and-Ed­ucation/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf, you will see that there is no time frame assigned to the results of any of the laboratory tests — in fact, for the results of any procedure that your provider can order.

Part of medical decision making (MDM) is the amount and/or complexity of data to be reviewed. As the Medicare documentation guidelines for E/M services state, “The amount and complexity of data to be reviewed is based on the types of diagnostic testing ordered or reviewed,” (emphasis added), not when the results are received.

This means that the results of test or procedures, whether they are received the same day or on any subsequent day, will not affect the way you level an evaluation and management (E/M) service on a given date of service.