wright10
New
I am seeing many differing opinions. Here is my general take away from the new 2021 guidelines: Per AMA and CPT "The actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when reported separately." There is no mention of order. The provider still had to use their medical decision making to decide which test to order, regardless of if we are billing for it or not. They also state "When the physician or other QHCP is reporting a separate CPT code that includes interpretation and/or report, the interpretation and/or report should not be counted in the medical decision making when selecting a level of office or other outpatient service." Again, this says nothing about him not being able to get credit for the ORDER. In addition, AMA/CPT says "Ordering a test is included in the category of test result(s) and the review of the test result is part of the encounter and not subsequent encounter." There is no mention as to if we are separately reporting it or not. To me, I am interpreting this to mean that if my provider orders and separately bills for a CBC and A1C on 01/01/21 I give him credit for ordering 2 labs. When he brings the patient back on 01/03/21 and goes over the results, I give 0 data points. Sometimes he may just have the nurse relay the results to the patient over the phone. In addition, if my provider orders a CT on 01/01/21 to be done at the hospital (not separately billed) and I give him credit for 1 ordering of a test. When he brings the patient back to review the radiologist report, that gets 0 data points. If my provider independently reviews the scan himself, I DO give credit for Category 2.