CPT Knowledge Base - Feb 9, 2022
If a physician or other QHP bills for a laboratory test, such as a hemoglobin A1c, may the physician or other QHP also obtain a credit for the review of that test and count the test as ordered or reviewed? Note that there is no separate interpretation performed. This question also applies to all office or other outpatient services codes (99202-99205, 99212-99215). ...
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Article Overview
This short coding guidance article explains a specific E/M documentation and medical decision-making question involving laboratory tests and professional interpretation. It is relevant to physicians and other qualified health professionals who report office or other outpatient services and need to understand how test review and ordering are handled when interpretation is not separately billed.
Why This Topic Matters
Accurate treatment of diagnostic test review and interpretation affects evaluation and management level selection and helps prevent inappropriate crediting of work that is already reported elsewhere.
What You Will Learn
- How laboratory test review is considered in the context of E/M medical decision-making
- How the article frames situations where separate interpretation is or is not reported
- Which office and other outpatient service code groups are implicated by the guidance
- How the guidance distinguishes ordered or reviewed tests from separately interpreted tests
Who Should Read This
- Physicians
- Other qualified health professionals (QHPs)
- Professional coders
- Coding compliance staff
- E/M documentation reviewers
Codes Discussed
Code Ranges Discussed
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