March 4, 2021

Question:
We do a lot of hand surgery and have an x-ray machine in the office. This has made me confused about how to count the data for the neurosurgeon’s E/M code. Please help.

Answer:

Good question and let’s simplify things. The AMA specifically states there should be “no incentive”, related to E/M coding, to the physician for ordering tests. So remember two things:

• If you order a test, no matter where it was performed you do not received Category 1 Data credit for reviewing it. You are supposed to review a test you order.
• If you, or your same specialty partner (plastic surgeon), bills for the test then you do not receive any Data credit in the E/M code. No credit for ordering, no credit for reviewing and no Category 2 credit for independent interpretation. Why? Because you are getting paid for the test so you cannot “double dip” and receive both E/M and test credit (billing, payment).

*This response is based on the best information available as of 03/04/21.