Wiki Ultrasound coding and E&M levels

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Fergie1128

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Hello,
Our practice has a radiology department where ultrasounds are preformed. Our physicians order several of these a week. The patients come back at a later date where the tests results are reviewed the patient. Can we use the ordering of the tests in the MDM if we are preforming by our own radiology dept?
Thank you for the help!
 
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Exactly - if your provider is ordering the ultrasound (or any test for that matter) AND performing/billing the test or professional component of that test, you may not count the order or review. The clinician is paid for that work by the billing of the test.
If your provider is ordering the ultrasound (or any test) and not performing/billing the test, you count the data for the order and review is included.
From the AMA 2021 guidelines:
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.
 
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Thank you very much for your help, I have not been including tests that we separately in the MDM but I have been questioned by the physicians regarding this. I just wanted to make sure this was correct.
Thank you again!
 
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Hi, I just wanted to make sure I am understanding correctly as I code for a multi-specialty facility. If a pain management physician sends the patient to the Radiology department in the same building for x-rays and a report and imaging is completed and then later interpreted by the pain management physician. The pain management practice does not bill for any part of the x-ray (technical or professional), the radiology department does. We cannot count the PM physician's interpretation toward MDM?

And why can we not even give credit for a test ordered?
 
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Queizati said:
Hi, I just wanted to make sure I am understanding correctly as I code for a multi-specialty facility. If a pain management physician sends the patient to the Radiology department in the same building for x-rays and a report and imaging is completed and then later interpreted by the pain management physician. The pain management practice does not bill for any part of the x-ray (technical or professional), the radiology department does. We cannot count the PM physician's interpretation toward MDM?

And why can we not even give credit for a test ordered?
Click to expand...
Hi there, is everyone in the same group?
 
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Queizati said:
Yes, I believe so, all of the multi-specialty physicians provide medical care within the same facility under the same organization/entity, and all the billing/claims would be under the name of this entity/organization.
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In that case your group can either bill for the test or count it toward MDM. You can't do both even though different specialties were involved. The AMA has specifically stated that it designed the guideline that way to make sure it didn't encourage excessive testing. You may want to consider an internal policy that prevents "double-dipping."
 
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jkyles@decisionhealth.com said:
In that case your group can either bill for the test or count it toward MDM. You can't do both even though different specialties were involved. The AMA has specifically stated that it designed the guideline that way to make sure it didn't encourage excessive testing. You may want to consider an internal policy that prevents "double-dipping."
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When you say 'your group' you are referring to the facility as a whole and not the pain management department specifically correct? The pain management dept. does not have its own x-ray/MRI machines so that is why the patient gets sent to our radiology department and the radiology department bills since they are using the equipment and their radiologist do the interpretations; so in that regard, our PM physicians would never bill out for any component of the imaging.
 
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lgardner said:
so, it sounds like your facility is billing for the x-ray.

if you bill for the service, you cannot count it towards MDM.

you can't get "credit" for the order, because you are receiving payment for it...that is the credit.
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Correct, the facility bills the x-ray for the work done by the radiologist. This will be tough to explain to our physicians; I can already see the pushback
 
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