I have a CNP who billed an office visit on 4/4/18 and told the patient that if his (chest pain) symptoms progressed, he should return and a stress test would be performed. The patient called back 8 days later and the CNP ordered the nuclear stress test. An addendum was made to the 4/14/18 note. Can the stress test be used to achieve a higher level of service for the 4/4/18 encounter?

Summary of encounter: Patient had increasing angina. Progressive symptoms were discussed with the interventional cardiologist. It was decided that the patient should continue to maximize medical therapy. "We will have the patient return for stress testing if his symptoms do not improve." The patent called the CNP on 4/12/18 and noted no improvement in his symptoms. A myoview stress test was ordered for the next day. Can the plan for the myoview stress test be counted in the MDM for 4/4/18, or because the "final decision" for it was not made until 8 days after the face-to-face encounter, does it not count toward the level on 4/14/18?

Pam Schmitt, RHIA, CCS, CCS-P, CPC