BC Advantage - 2021 Issue 4
Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?
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Article Overview
This article addresses an E/M documentation question involving tests ordered in one part of a group practice and performed in another. It explains the broad CPT concepts behind external versus internal sources, how same-group specialty and subspecialty relationships affect E/M data counting, and why these distinctions matter for coders and auditors handling medical decision making documentation.
Why This Topic Matters
Correctly identifying whether a source is considered external can change what may be counted in E/M data element work. The topic is especially relevant for coders, auditors, and practices with multiple departments or specialties billing under the same tax ID.
Article Sections
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Question
Introduces the coding question involving tests ordered and performed within a larger multi-department clinic structure.
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Answer
Summarizes the CPT framework used to evaluate whether a source is external in a group practice setting and discusses the related E/M concept at a high level.
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Scoring
Presents a sample scenario and explains the broad E/M data element areas discussed in the article, including how different test relationships are handled in the example.
What You Will Learn
- How CPT concepts distinguish external from internal sources in a group practice
- Why specialty and subspecialty relationships matter for E/M documentation review
- How multi-department testing scenarios relate to E/M medical decision making data
- What kinds of situations are commonly discussed by coders and auditors in this context
Who Should Read This
- Medical coders
- Coding auditors
- Physician practices
- E/M documentation staff
- Compliance professionals
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