decisionhealth Newsletters, Part B News - 2023 Issue 5 (May)
After correction, review the rules for counting a test interpretation toward MDM
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Article Overview
This premium coding article reviews a March 1 AMA correction and its impact on how test orders, reviews, and interpretations are considered for medical decision-making in E/M coding. It is aimed at coding professionals and clinical practices that bill diagnostic testing and want to understand how the updated clarification fits with existing 2023 CPT guidance. The discussion focuses on the difference between separately reported testing and test activity that may count toward the data review portion of MDM, along with timing considerations for assigning the credit to the appropriate encounter.
Why This Topic Matters
This matters because small changes in how test-related activities are counted can affect E/M leveling and coding accuracy. The article helps readers avoid misapplying the AMA correction and supports consistent documentation and billing practices.
Article Sections
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Coding
Overview of the AMA correction and its relevance to E/M medical decision-making. The section frames the coding question addressed by the article.
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Questions and Answers
A guided discussion of common scenarios involving test ordering, review, interpretation, and timing. The section compares the correction with existing CPT guidance and clarifies the scope of the update.
What You Will Learn
- How a March 2023 AMA correction relates to E/M medical decision-making
- How test orders, reviews, and interpretations are generally considered in coding workflows
- How timing can affect which encounter receives credit for test-related activity
- How the article distinguishes separately reported testing from MDM data review
Who Should Read This
- Medical coders
- Billing staff
- Physician practices
- Compliance teams
- E/M documentation specialists
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