There are various interpretations and questions on how to use 2 new elements under the section:
Data To Be Reviewed > Category 1 > ordering and review of the results of “unique tests.”
- Have you been trained to give credit for both ordering and reviewing tests (total 2 credits) ?
- Or, have you been trained to give credit for ordering and reviewing the same test only once (total 1 credit) ?
Jill Young, CEMA, CPC, CEDC, CIMC pointed us to page 14 of the AMA 2021 CPT(R) Manual.
The 2021 AMA CPT Manual states “… 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.”
Dr. Magoon, DO, JD, MBA, MPH, CMQ provided this reply to a question in his blog “Quick Tips” for the AAFP FPM Journal.
“If I review a previous A1c and order a new A1c during the same encounter, does this count as two points under data reviewed?
No. Each unique test will count as one point and a unique test is defined by its CPT code. Since this is the same test with the same CPT code, the reviewing of the previous test and ordering of the new one will together count only as one point.”
If we break down Dr. Magoon’s reply, it is consistent with the AMA’s guidelines. If a unique test is counted at time of ordering, it is credited once in determining an Outpatient E/M code. In the example above, the ordering of the A1c in the “previous encounter” can be counted for the E/M of that encounter. The ordering of the new A1c in the current encounter can be counted for the E/M of the current encounter.
What other grey areas might you run into in counting unique tests for the 2021 E/M MDM grid by the AMA?
We hope you’ll share your thoughts with us!