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Last Modified: 8/5/2022 Location: FL, PR, USVI Business: Part A, Part B

E/M FAQ -- Determining overall risk for medical decision-making

Q. Is prescription drug management enough to establish a moderate level of risk for medical decision-making?
A. The risk of significant complications, morbidity, and/or mortality of patient management is based on the risks associated with the following categories:
Presenting problem(s);
Diagnostic procedure(s); and
Possible management options
The assessment of risk of selecting diagnostic procedures and management options is based on the risk during and immediately following any procedures or treatment. The highest level of risk in any one category determines the overall risk, and in the category of possible management options, prescription drug management is an example of a moderate level of risk.

Changes to office and outpatient evaluation and management (E/M) services for 2021

NOTICE -- Effective for dates of service on and after January 1, 2021, practitioners have the choice to document office and outpatient E/M visits via medical decision making (MDM) or time. CMS adopted the American Medical Association's (AMA's) CPT revised guidance, including deletion of CPT code 99201. The E/M code and guideline changes are specific for office and other outpatient visits and apply to codes 99201-99205 and 99211-99215. Based on the CPT changes, code 99201 is no longer valid for dates of service on and after January 1, 2021, as clinicians may choose the E/M visit level based on either medical decision making or time, both CPT code 99201 and 99202 previously require straightforward medical decision making, therefore the decision was made to delete CPT code 99201.
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