2021 E/M Data Scoring

Prepare yourself, your staff and your providers for the 2021 E/M changes.

Moderators: NAMAS Moderator, Shannon DeConda

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lori
Posts: 47
Joined: Fri Aug 03, 2012 10:22 am

Wed Jul 07, 2021 4:55 pm

Hi. At an office visit, the cardiologist orders an echocardiogram which isn't performed on that day. It's unknown when or where the patient will eventually have the echo, who will bill for the professional component, and whether the patient will actually even follow through with having the echo at all.

My question is, can the cardiologist get Data credit toward the E/M for ordering the echo, since the echo hasn't been performed yet and since the professional component hasn't been billed separately as of the date of the E/M? Keep in mind that there's a possibility that this provider could end up billing the professional component for the echo if/when it's performed, which could be a month or two after the E/M occurred.

This is a common scenario but the language in the AMA guidance seems unclear on how to handle this. Thank you for your input!
jeskla
Posts: 18
Joined: Wed Feb 12, 2020 8:30 pm

Fri Sep 10, 2021 12:34 am

It is my understanding that if the same cardiologist performs the interpretation/report and bills separately for that echo on that date or a future date then they can’t get the data point for ordering it even though the echo may or may not be done on the date of the E/M. However, if the echo interpretation is never separately reported then they can have the data point for ordering. It seems you are in an impossible situation unless you have a magic 8 ball or better yet develop an internal policy stating company protocol for this situation. In my honest opinion it’s really not about the dates in this situation. It’s about not giving ordering MDM credit to the same physician who’s going to bill for that echo because a portion of payment for that echo includes ordering it.
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