Wiki Rapid Strep as a Unique Test

[Stefanie1023]

I am currently an NP and in the process of becoming a certified E/M coder. If we order a strep/flu/COVID test in house, but it's billed as its own CPT code on the encounter, can it still count as an element in MDM under the category of amt of data/complexity of data? I can't seem to find a clear answer. We've always counted it as one element (either ordered or reviewing the result), but is this correct as it's billed separately by our office. Labs are done in house, but aren't billed by the office so these are counted towards MDM. Thanks for any clarification!

 

[jkyles]

Hi there,
The guidelines state that you can count results-only tests that are performed in office (for example, rapid strep). So yes, depending on the type of test you use.

 

[lgardner]

jkyles is correct. the review of a unique test includes interpretation. if it is a rapid test, that does not require interpretation, it can be counted as an "order".

here it is in writing..

per the AMA - 2021 E/M technical corrections:

Services Reported Separately
Any specifically identifiable procedure or service (ie, identified with a specific CPT code) performed on the date of E/M services may be reported separately.


The ordering and 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 the professional interpretation of those tests/studies is reported separately by the physician or other qualified health care professional reporting the E/M service. Tests that do not require separate interpretation (eg, tests that are results only) and are analyzed as part of MDM do not count as an independent interpretation, but may be counted as ordered or reviewed for selecting an MDM level. 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 MDM.