If an otherwise separately reportable test is ordered by the physician or other QHP and used in the MDM at the encounter ( 99202 - 99215 ), but is not billed, may the test be counted when selecting the MDM level? For example, in ophthalmology, when optical coherence tomography ( 92134 ) and fundus photography ( 92250 ) are ordered, performed, and documented (review and report), and used as part of the MDM level selection for the encounter ( 99202 - 99215 ), code 92250 cannot be reported with code 92134 ; therefore, code 92250 is not reported. ...

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Note:  The following article synopsis was NOT provided by the AMA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article discusses how CPT E/M office and other outpatient visit medical decision-making guidance treats diagnostic tests that are ordered, performed, reviewed, and interpreted during the encounter. It is aimed at coders, billers, and clinicians working with office/outpatient E/M documentation, especially in specialties that commonly use diagnostic testing. The content focuses on CPT guideline language, office/outpatient E/M MDM selection, and the distinction between tests that require separate interpretation and those analyzed as part of MDM, while also noting that payer policies may differ from CPT guidance.

Why This Topic Matters

Correctly understanding how diagnostic testing interacts with office and outpatient E/M MDM selection is important for compliant reporting and for avoiding conflicts between CPT guidance and payer-specific policies.

Codes Discussed

• CPT: 99202
• CPT: 99215
• CPT: 92134
• CPT: 92250

Code Ranges Discussed

• CPT: 99202-99215

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