Wiki MDM for X-ray Billing in office and other facility interpretations

[cwilson3333]

If our office performs x-rays during office visit, and reviews x-rays with patient same visit, how is that counted toward MDM complexity of data to be reviewed and analyzed
For instance if bilateral x-rays are done, does this count as ordering of 2 "tests" and Review of 2 "tests" [moderate MDM]

Second scenario, if doctor orders an MRI, an patient returns following week for results, what level MDM does this meet

Hopefully, I am not confused by the new 2021 guidelines, and have not confused anyone reading this thread.

Seems fairly easy to be billing a "lot" of moderate [99214] codes with the new guidelines.

 

[Cboucher]

Hi,
I did some asking around, and got one of my experts to weigh in on your question. Please use this info only as a guide and consult with your payer before filing any claims. Thanks!
Best
Chris Boucher, MS, CPC
Senior Development Editor

ANSWER:
If the x-ray is performed and BILLED, then it cannot be counted in the MDM.
If the MRI is ordered, credit is given then. Credit cannot be given when the results are discussed. The discussion can glean credit, but not the test result.

 

[ccoleman822]

If our office performs x-rays during office visit, and reviews x-rays with patient same visit, how is that counted toward MDM complexity of data to be reviewed and analyzed
For instance if bilateral x-rays are done, does this count as ordering of 2 "tests" and Review of 2 "tests" [moderate MDM]

Second scenario, if doctor orders an MRI, an patient returns following week for results, what level MDM does this meet

Hopefully, I am not confused by the new 2021 guidelines, and have not confused anyone reading this thread.

Seems fairly easy to be billing a "lot" of moderate [99214] codes with the new guidelines.

You cannot count the xrays towards MDM, considered double dipping. Our office does the same thing with xrays, so I was also confused until someone explained it as anything billed on DOS cannot be counted toward MDM. The MRI test can, because it is being ordered and done somewhere else.

 

[TPeniston61]

I'm sorry, but this makes no sense. If we can't count x-rays, in our practice, toward the MDM, then we could never receive credit for them. They are data that needs to be reviewed and interpreted in order to make decisions regarding the patient's treatment. Orthopedists rely on x-rays to be able to properly design a plan for recovery. Also, when we do x-rays, the interpretation and discussion with the patient is typically the same day.

 

[csperoni]

I believe the theory is that you are being paid for the x-ray and interpretation (by the xray 70000 CPT code). That is your credit. Therefore, you cannot receive data credit to review the interpretation that you just created. That is the "double dipping". You are getting MDM risk credit when developing the treatment plan based on the xray. For example - prescription, or surgery discussion, etc. It's just the data you may not count since you are already being paid to interpret the xray.
Similarly, if you bill E/M based on time, you may not count the time spent on the xray. You may count the time spent discussing the xray result with the patient, but not performing or writing xray report.
I'm not saying I 100% agree with it. Just trying to provide the rationale behind it.

 

[mckeek88@gmail.com]

We are billing a lot of 99202 for new patients because you can't count the x-rays in the MDM. Sometimes our doctors may order an MRI or review an outside MRI but that's only 1 element in the MDM section and you need 2 elements for a 99203 level. It definitely stinks and I wish they would change this part of it for specialties like orthopedics because it makes it very difficult to get above a 99202 for new patients.

 

[csperoni]

We are billing a lot of 99202 for new patients because you can't count the x-rays in the MDM. Sometimes our doctors may order an MRI or review an outside MRI but that's only 1 element in the MDM section and you need 2 elements for a 99203 level. It definitely stinks and I wish they would change this part of it for specialties like orthopedics because it makes it very difficult to get above a 99202 for new patients.

I would think you could often get a level 3 in ortho fairly easy.
Problems: 1 stable chronic or 1 acute uncomplicated illness/injury
Risk: Low (OTC meds, PT, etc)
If you are ordering rx, or surgery, your risk would even be moderate.
Also, don't forget about assessment requiring an independent historian. For younger pediatric patients or older patients with memory issues, it's a common occurrence, but you should remind your clinicians to document it.