For MDM, you need 2 of 3 sections. Throw out the lowest score. The new visit codes 99202-99205
| MEDICAL DECISION MAKING 2 out of 3 need to be met | ||||||||
| Straightforward (99212/99202) | Low Complexity (99213/99203) | Moderate Complexity (99214/99204) | High Complexity (99215/99205) | |||||
| A. # of DX | Minimal (0-1) | Low (2) | Moderate (3) | High (4+) | ||||
| B. Data Reviewed | Minimal (0-1) | Low (2) | Moderate (3) | High (4+) | ||||
| C.*RISK | Minimal | Low | Moderate | High | ||||
| A. Number of Diagnoses/Management Options (see row A above) | B. Amount Complexity of Data (see row B above) | |||||||
| Self-limited/minor (2 max)SL | x1 | Lab tests (ordering or reviewing) | 1 | |||||
| Established Prob that is stable/improving | x1 | Radiology (ordering or reviewing, e.g. X-rays) | 1 | |||||
| Established Prob that is worsening / uncontrolled | x2 | Medical studies e.g. ECGs, PFTs (ordering or reviewing) | 1 | |||||
| New Prob no workup (3 max)NP | x3 | Discussing contradictory/unexpected test results w/ the testing physician. | 1 | |||||
| New Prob additional workup | x4 | Requesting old records or obtaining hx from a source other than the patient, such as a family member or an emergency medical technician. | 1 | |||||
| Total | Reviewing old records and summarizing them in the record | 2 | ||||||
| Independently reviewing an image, specimen, or tracing | 2 | |||||||
| Total | ||||||||
| C. Risk (see row C above). See the MDM TABLE OF RISK. Choose the level of risk of significant complications morbidity, and/or mortality – Minimal, Low, Moderate, and High risk. The highest level determines the overall risk. |
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- Self-limited/minor = e.g cold, insect bite, Tinea corporis. Established prob worsening/uncontrolled e.g. when you have to make med changes etc.
- SL: You can only count two self-limited/minor problems for a total max of 2 points.
- Each stable established problem earns one point with no maximum
- Each established but worsening or uncontrolled problem earns two points,
- One new problem that does not need workup after the visit is worth 3 points and, if additional workup is needed, 4 points.
- NP: You can only count one new prob with no workup, for a max total of 3 points. There is no limit to the number of new problems with additional workup that you can count.
- Discuss test results w/ performing MD = You have to do it on phone/face-to-face, and you have to document it. Happens often in the hospital setting
- In section A, “new problem” or “established problem” means new to the provider or established to the provider. See more here.
- For data, section B, Each of the listed tests/tasks earns one point regardless of the number of tests/tasks ordered or performed.
Resources / References
Fam Pract Manag. 2014 Nov-Dec;21(6):12-16. https://www.aafp.org/fpm/2014/1100/p12.html
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf