When a provider reports a test with a separate CPT code, the ordering, performance, and interpretation is not included in the MDM for E/M visits. Which tests are considered in the MDM despite this rule?

When a provider reports a test with a separate CPT code, the ordering, performance, and interpretation is not included in the MDM for E/M visits. Which tests are considered in the MDM despite this rule?

• A. Point-of-care tests such as rapid strep, rapid flu, and rapid COVID-19
• B. Imaging studies
• C. Hospital laboratory tests billed separately
• D. Surgical procedures

Answer: (A)

Point-of-care tests performed during the visit provide immediate data used to guide management, and these results are counted in the data portion of the MDM even if a separate CPT code is billed. Rapid tests like strep, flu, and COVID-19 are classic examples because their results are available right away and directly influence clinical decisions during the encounter, so they contribute to the MDM despite the billing separation. In contrast, tests and procedures that are billed separately outside the encounter—such as imaging studies, hospital lab tests, or surgical procedures—don’t feed into the MDM for that visit. They’re considered external data or services and aren’t included in the MDM data count.

Point-of-care tests performed during the visit provide immediate data used to guide management, and these results are counted in the data portion of the MDM even if a separate CPT code is billed. Rapid tests like strep, flu, and COVID-19 are classic examples because their results are available right away and directly influence clinical decisions during the encounter, so they contribute to the MDM despite the billing separation. In contrast, tests and procedures that are billed separately outside the encounter—such as imaging studies, hospital lab tests, or surgical procedures—don’t feed into the MDM for that visit. They’re considered external data or services and aren’t included in the MDM data count.