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| evaluation_management_coding_2021 [2025/01/29 15:24] – Scott Larson | evaluation_management_coding_2021 [2025/06/05 03:07] (current) – Scott Larson |
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| ====== E&M Coding ====== | ====== E&M Coding ====== |
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| {{::2021emcoding.pdf |Coding Table 2021 for download}}\\ | [[https://1drv.ms/b/c/31d83ae8e55e0542/EaXnSv-01DlLhsPYocbMdg4BK9Zt5Tq1NGEXw6usQBXofw?e=cxsce3|E&M Worksheet]] \\ |
| {{::2021_em_changes_-_handout_final_11.2021.pdf |UIHC E&M Coding Guidance 2021}} | [[telemedicine|See Telemedicine codes]] |
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| ==== Elements of Medical Decision Making ==== | ==== Elements of Medical Decision Making ==== |
| |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 | | |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 | | | 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 | | | 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 | |
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| | ==== Coding by Time ==== |
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| | ^New Patient Code^Total Time (minutes)^ |
| | |99202|15-29| |
| | |99203|30-44| |
| | |99204|45-59| |
| | |99205|60-74| |
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| | ^Established Pt Code^Total Time (minutes)^ |
| | |99212|10-19| |
| | |99213|20-29| |
| | |99214|30-39| |
| | |99215|40-54| |
| {{tag>coding}} | {{tag>coding}} |