Wiki Data Points for ordering x-ray & reading & reviewing original films

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mrolf

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If a physician orders an x-ray (1 data point) and then he reads and reviews the original films (2 data points) would the total of data points be 3 points?? Some coders feel that you can only count 2 points for ordering and visualizing or reading the films. What is the correct way to count data points in this situation, which happens all the time. Need a definite answer. Thanks.
 
I think it depends on the scenario. Are you also billing for these films having been performed in your office? If so, I wouldn't also give credit for the read; only the single point for the order. It could be considered "double dipping" or padding the E&M if you get E&M credit and also get reimbursed for the technical charge and the read.

Typically the order/read don't happen on the same encounter, unless the encounter is for acute care. Personally, I wouldn't ever assign three points for both the order and the visualization, I'd assign the two points if the provider's report in the documentation states the findings and their significance to the treatment planning and that they personally viewed the images. It's not enough to say "I reveiewed the films". If they don't document that, I'd only assign the single point for the order.
 
This is just my own opinion based on experience and the addition of information from one of our Medicare MAC's; Novitas to help resolve the thought process.

We must be careful in stating "x-rays are never ordered and performed at the same visit." Often x-ray's are ordered and read at the same visit, especially for orthopedists. They have x-ray machines in the office and they wouldn't have a patient come back for a separate appointment to get the results of the films. Sometimes a provider will view previous films and take new films of a contralateral body area such as the shoulder or the same shoulder for comparison. There are a multitude of scenarios where 1 point for ordering and 2 points for viewing films could potentially be useful to the provider.

Novitas makes it clear that if the physician bills (meaning is getting paid) for the professional portion of the x-ray, then they cannot get the 2pts in the Data Section of the MDM for the E&M. They would only get 1 point for ordering of the x-ray. Some offices have the x-ray's sent out to be formally read based on a contract they have with the hospital they are attached to or for whatever reason. Thus, the ordering provider is not getting reimbursed for the read and they can gain the 2 points for "viewing the films". But I suggest to physicians to give a paragraph description of their findings. Don't leave it "normal" or "abnormal" findings.

Source: https://www.novitas-solutions.com/em/independent-visualization.html
 
mworcester said:
We must be careful in stating "x-rays are never ordered and performed at the same visit."
Click to expand...

I think if you read carefully, your comment in quotations does not at all mirror my post. I did not say that these are NEVER done at the same time....they are typically not done at the same time, and if they are, it is because the provider also bills for the global rad service or the professional component; in either case the provider should not also get significant credit for the data points for the concurrent E&M. As a professional courtesy, I hope you understand that I needed to clarify your interpretation of my response.
 
Along these same lines...

how would you give credit for rapid strep tests? Does the provider get 1 point for ordering it and two points for reading it (total of three)? I have a hard time justifying that in my mind - would give the two points. Would like to know what others think.

Seems strange to ask about this in the summer - but I am reviewing some records from the 1st quarter and here in the Northeast, we see a LOT of those during the winter!
 
To give one pt to ordering and two for reading it would be double dipping. Also, looking at a strep test to see if it is positive is not the intent of independently viewing a film, tracing or slide. Think about the work that goes into those actions and think about looking to see if something is positive or negative. I would give one pt to ordering a lab for a strep test.

Good questions. Good discussion.
 
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