Wiki question on subspecialty for 2021 E&M guidelines/are audiologists a subspecialty of ENT?

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wynonna

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Hello: Regarding hearing tests being interpreted by an ENT MD from hearing tests conducted by audiologists, can they each be counted as a point per each interpretation (one point per exam)? I mean for the MD E&M Office visit portion.
In other words, we are allowed to count these hearing tests, but only if our audiologists are considered a subspecialty of Ear, Nose and Throat Assoc.?
thank you
 
I am understanding that you are asking if you can count interpreting the test toward the "amount of data" column of MDM.
If you are billing for the test, you may not count ordering or interpreting the test. I would assume you are billing for the test you are performing.
You can only count a data point for tests you are not billing separately for. This has nothing to do with the specialty or subspecialty. If I am misunderstanding your question, please let me know.

From the AMA guide (full guide here https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf):
Page 2: Any specifically identifiable procedure or service (ie, identified with a specific CPT code) performed on the date of E/M services maybe reported separately. 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. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The physician’s interpretation of the results of diagnostic tests/ studies (ie, professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended. If a test/study is independently interpreted in order to manage the patient as part of the E/M service, but is not separately reported, it is part of medical decision making

Page 6: The amount and/or complexity of data to be reviewed and analyzed. This data includes medical records, tests, and/or other information that must be obtained, ordered, reviewed, and analyzed for the encounter. This includes information obtained from multiple sources or interprofessional communications that are not separately reported. It includes interpretation of tests that are not separately reported. 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 a subsequent encounter. Data is divided into three categories:
•Tests, documents, orders, or independent historian(s). (Each unique test, order or document is counted to meet a threshold number)
•Independent interpretation of tests.
•Discussion of management or test interpretation with external physician or other qualified healthcare professional or appropriate source
 
wynonna said:
Hello: Regarding hearing tests being interpreted by an ENT MD from hearing tests conducted by audiologists, can they each be counted as a point per each interpretation (one point per exam)? I mean for the MD E&M Office visit portion.
In other words, we are allowed to count these hearing tests, but only if our audiologists are considered a subspecialty of Ear, Nose and Throat Assoc.?
thank you
Click to expand...
Independently interpreting a test performed by another physician or other qualified health care professional (QHP). Note that physicians and QHPs can only count this toward the MDM when they cannot report the service using another CPT code. if required the Audiologists will bill the hearing CPT 92551, for the service done and interpreted by him. ENT done only interpretation can count for EM.

 
So our audiologist only performs a hearing test, and bills for the performance of test only. Our MD then separately interprets the test results and goes over them with the patient. It is the same MD who ordered and reads the hearing test. So the MD is not only ordering the test, but interpreting it and summarizing the results with the patient. Does this count as 1 point for "review of results one unique test"?
 
To put is simply, the ordering and review of a test can only be counted once. With regards to the previous answers, if the test was performed and billed for by that physician, than it cannot be counted as data with regards to the MDM. I think it gets a little tricky with Audiologists that are employed by the ENT groups, although they may credentialed and bill under their own NPI most likely they all bill under the same group tax ID # and therefore are considered part of that group. With that thought in mind than the group is billing for the service and again, it would not be counted towards the data element of MDM. Please, anyone, correct me if I am wrong.
 
So the MD is seeing the patient, he orders a tympanogram which is performed by the Audiologist. I understand the MD cannot count the interpretation or review of results because the practice is billing for the test. But my understanding was he could receive credit for "ordering unique test". Now I am being told this is not correct that because the practice is billing for the test he cannot get credit. I need clarification for my docs. Also if the order a CT scan, which is performed and the TC is billed by the practice and and outside Radiologist performs the interpretation does out MD get to count the ordering of the CT? Does he get to count review of test results at a subsequent visit?
 
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