E/M, E&M, Evaluation and Management, Office/Outpatient Visits 99202-99215
Evaluation and Management - Series Four
July 26, 2021
This is the fourth in the Evaluation and Management Series for Office/Outpatient Visits 99202-99215.
We have reviewed Number and Complexity of Problems Addressed, and Amount and/or Complexity of Data to be Reviewed and Analyzed. The last component is Risk of Complications and/or Morbidity or Mortality of Patient Management, and was previously known as The Table of Risk. The new Table of Complications and Risk is very similar to the 2020 Table, but there are some Additions and Deletions.
Table of Complications and/or Morbidity or Mortality of Patient Management
Risk: Risk is the probability and/or consequences of an event affected by the nature of the event under consideration. Definitions of risk are based upon the usual behavior and thought processes of a physician or other QHP in the same specialty. For the purposes of medical decision making, the level of risk is based on the consequences of the problem(s) addressed in the encounter. Risk also includes medical decision making related to initiate or forgo further testing, treatment, and/or hospitalization. The term "risk" as used in these definitions relates to the risk from the condition. While conditions of risk and management risk may often correlate, the risk from the condition is distinct from the risk of management.
Morbidity: Morbidity is a state of illness that is expected to be of substantial duration during which function is limited, quality is impaired, or there is organ damage that may be transient despite treatment.
Drug therapy requiring intensive monitoring for toxicity: A therapeutic agent may have the potential to cause serious morbidity or death. The monitoring is assessed of these adverse effects not primarily for assessment of therapeutic efficacy. The monitoring should be that which is generally accepted practice for the agent but may be patient specific. The monitoring may be by a lab test, a physiologic test, or imaging. Monitoring by history does not qualify. Examples may include monitoring for cytopenia in the use of antineoplastic agent between dose cycles. Monitoring of glucose levels during insulin therapy as the primary reason for therapeutic treatment does not qualify for this MDM.
Maxine Lewis, CMM, CPC, CPC-I, CPMA, CCS-P, is a member of the National Society of Certified Business Consultants and is a nationally recognized lecturer, author, and consultant in the healthcare industry, combining more than 40 years of practical experience in the medical office with an in-depth understanding of coding, reimbursement, and management issues of the medical profession.