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.
  •  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

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