Medicare Compliance & Reimbursement - 2023 Issue 6
Reader Questions: Recognize When ‘Reviewed’ is Tethered to an Order
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Article Overview
This short educational article addresses a common coding question about how provider review of a test is handled when an order already exists, with emphasis on medical decision making (MDM) and CPT guidance. It is aimed at coders, auditors, and clinicians who support office and outpatient evaluation and management documentation. The piece discusses the general relationship between ordered services, reviewed information, and data elements used for visit leveling, including a limited exception involving work performed by a different provider.
Why This Topic Matters
Correctly understanding whether review work is counted separately affects E/M leveling accuracy and helps avoid improper duplication of credit in documentation review.
What You Will Learn
- How review of a previously ordered test relates to MDM data elements
- Why some review activity may already be captured by a separately reported CPT service
- When review performed by a different provider may be considered separately for leveling purposes
- How this issue fits into common office and outpatient visit documentation review practices
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Physicians
- Other qualified health professionals
- Clinical documentation specialists
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