MDM |
CPT Code |
MDM Elements |
Time (Mins) |
N/A |
99211 (established) |
N/A |
N/A |
Straightforward |
99202 (New) |
Problems: 1 self-limited or minor |
15-29 |
99212 (established) |
Data Complexity: Minimal |
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Morbidity: Minimal |
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Low |
99203 (New) |
Problems: Low |
30-44 |
99213 (established) |
§ 2 or more self-limited or minor problems; or |
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§ 1 stable chronic illness; or |
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§ 1 acute, uncomplicated illness or injury |
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Data Complexity: Must meet one of the categories below. |
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§ Category 1: Tests and documents. Any combination of 2 from the following: |
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· Review of prior external note(s) from each unique source; |
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· review of the result(s) of each unique test; |
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· ordering of each unique test |
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§ Category 2: Assessment requiring an independent historian(s) |
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(For the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high) |
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Morbidity: Low risk of morbidity from additional diagnostic testing or treatment |
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Moderate |
99204 (new) |
Problems: |
45-59 |
99214 (established) |
§ 1 or more chronic illnesses with exacerbation, progression, or side effects of treatment; or |
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§ 2 or more stable chronic illnesses; or |
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§ 1 undiagnosed new problem with uncertain prognosis; or |
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§ 1 acute illness with systemic symptoms; or |
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§ 1 acute complicated injury |
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Data Complexity: Must meet one of the categories below. |
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§ Category 1: Tests, documents, or independent historian(s). Must be any combination of 3 from the following: |
|||
· Review of prior external note(s) from each unique source; |
|||
· Review of the result(s) of each unique test; |
|||
· Ordering of each unique test; |
|||
· Assessment requiring an independent historian(s) |
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§ Category 2: Independent interpretation of tests another physician/other qualified health care professional (not separately reported); |
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§ Category 3: Discussion of management or test interpretation with external physician/other qualified health care professional\appropriate source (not separately reported) |
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Morbidity: Moderate risk |
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High |
99205 (New) |
Problems: |
60-74 |
99215 (established) |
§ 1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment; or |
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§ 1 acute or chronic illness or injury that poses a threat to life or bodily function |
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Data Complexity: Must meet one of the categories below. |
|||
§ Category 1: Tests, documents, or independent historian(s). Must be any combination of 3 from the following: |
|||
§ Review of prior external note(s) from each unique source; |
|||
§ Review of the result(s) of each unique test; |
|||
§ Ordering of each unique test; |
|||
§ Assessment requiring an independent historian(s) |
|||
§ Category 2: Independent interpretation of tests performed by another physician/other qualified health care professional (not separately reported); |
|||
§ Category 3: Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported) |
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Morbidity: High Risk |
