====== E&M Coding ====== {{::2021emcoding.pdf |Coding Table 2021 for download}}\\ {{::2021_em_changes_-_handout_final_11.2021.pdf |UIHC E&M Coding Guidance 2021}}\\ [[telemedicine|See Telemedicine codes]] ==== Elements of Medical Decision Making ==== **Documentation Must Support 2/3 Elements** ^ Element 1\\ Number and Complexity of Problems Addressed ^ Element 2\\ Amount and/or Complexity Data to be Reviewed and Analyzed ^ Element 3\\ Risk of Complication and/or Morbidity or Mortality of Patient Management. ^ Level of MDM | | 1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment; or\\ 1 acute or chronic illness or injury that poses a threat to life or bodily function | **Extensive**\\ (Must meet the requirements of at least **2 out of 3 categories**)\\ //__Category 1__//: Tests, documents, or independent historian(s) or Any combination of **3** from the following: \\ (1) Review of prior external note(s) from each unique source; \\ (2) Review of the result(s) of each unique test; \\ (3) Ordering of each unique test; \\ (4) Assessment requiring an independent historian(s)or \\ //__Category 2__//: Independent interpretation of tests- \\ Independent interpretation of a test performed by another physician or other qualified health care professional (not separately reported) or \\ //__Category 3__//: Discussion of management or test interpretation: \\ Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported) | High risk of morbidity from additional diagnostic testing or treatment \\ Examples only:\\ -Drug therapy requiring intensive monitoring for toxicity\\ -Decision regarding elective major surgery with identified patient procedure risk factors\\ -Decision regarding emergency major surgery\\ -Decision regarding hospitalization\\ -Decision not to resuscitate or to deescalate care because of poor prognosis | HIGH\\ 99205 New Patient\\ 99215 Established Patient | |1 or more chronic illnesses with exacerbation, progression, or side effects of treatment; or \\ 2 or more stable chronic illnesses; or \\ 1 undiagnosed new problem with uncertain prognosis; or \\ 1 acute illness with systemic symptoms or \\ 1 acute complicated injury | **Moderate** \\ //(Must meet the requirements of at least **1 out of 3 categories**)// \\ //__Category 1__:// Tests, documents, or independent historian(s) or \\ Any combination of 3 from the following: \\ (1) Review of prior external note(s) from each unique source; \\ (2) Review of the result(s) of each unique test; \\ (3) Ordering of each unique test; \\ (4) Assessment requiring an independent historian(s) or \\ //__Category 2__//: Independent interpretation of tests \\ Independent interpretation of a test performed by another physician/other/qualified health care professional (not separately reported); or \\ //__Category 3__//: Discussion of management or test interpretation \\ Discussion of management or test interpretation with external physician/other qualified health care professional\appropriate source (not separately reported) | Moderate Risk of morbidity from additional diagnostic testing or treatment \\ Examples only:\\ -Prescription drug management \\ -Decision regarding minor surgery with identified patient or procedure risk factors \\ -Decision regarding elective major surgery without identified patient or procedure risk factors \\ -Diagnosis or treatment significantly limited by social determinants of health | MODERATE \\ 99204 New Patient \\ 99214 Established Patient | | 2 or more self-limiting minor problem or 1 stable chronic illness (well-controlled HTN) or \\ Acute uncomplicated illness or injury (cystitis, allergic rhinitis) | **Limited** //(Must meet the requirements of at least **1 of the 2 categories**)// \\ //__Category 1__:// Tests, documents, or independent historian(s) or \\ Any combination of **2 from the following:** \\ (1) Review of prior external note(s) from each unique source; \\ (2) Review of the result(s) of each unique test; \\ (3) Ordering of each unique test; or \\ //__Category 2__:// Assessment requiring an independent historian(s) (For the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high) | Low risk of morbidity from additional diagnostic testing or treatment | LOW\\ 99203 New Patient\\ 99213 Established Patient | | 1 self-limiting or minor problem (cold, tinea corporis) | Minimal or None. | Minimal risk of morbidity from additional diagnostic testing or treatment | STRAIGHT- FORWARD\\ 99202 New Patient\\ 99212 Established Patient | ==== Coding by Time ==== ^New Patient Code^Total Time (minutes)^ |99202|15-29| |99203|30-44| |99204|45-59| |99205|60-74| ^Established Pt Code^Total Time (minutes)^ |99212|10-19| |99213|20-29| |99214|30-39| |99215|40-54| {{tag>coding}}