Counting unique tests under the new guidelines

Q:

Please help clarify the Data section of MDM under the new CPT/AMA guidelines and counting unique tests.  For example, the provider ordered a chest x-ray, an MRI and a CT, how is this counted?  And what if the provider ordered three different lab tests?

A:

Great questions!  Let’s first review the instructions in the CPT code book. CPT defines tests as imaging, laboratory, psychometric or physiological data.  CPT states “The differentiation between single or multiple unique tests is defined in accordance with the CPT code set.” CPT also states that a lab panel is considered a single test. 

Now that we have a better understanding of the CPT instructions, here are some examples:

  • A single lab test (e.g., TSH) is counted as one unique test.
  • A lab panel (e.g., CMP or BMP) is counted as one unique test even though there are multiple components.  Be sure to familiarize yourself with the lab panels in CPT so you can avoid incorrect counting. 
  • A chest x-ray is considered one unique test, as is the MRI and the CT (all have a different CPT code).  In this case, if all three are ordered and none are billed by your clinic, you may count as 3 unique tests.  If the chest x-ray was billed by your clinic, but the MRI and CT were not, you may count as 2 unique tests.   

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