Crystal's MCW Coder HubOverview
To select the E/M level based on MDM, 2 out of 3 elements must meet or exceed the threshold.
2023 CPT MDM Table
MDM Level Selection
Rule: Meet or exceed 2 of the 3 elements below.
| Level | Problems Addressed | Data Reviewed & Analyzed | Risk of Complications |
|---|---|---|---|
| Straightforward | 1 Self-limited or minor problem | Minimal 1 Category | Minimal OTC meds, minor injury |
| Low | 2+ Self-limited OR 1 Stable chronic OR 1 Acute uncomplicated | Limited 2 Categories | Low Prescription mgmt, PT/OT, minor surgery |
| Moderate | 1 Stable chronic + 1 Acute OR 2+ Stable chronic OR 1 Undiagnosed new OR 1 Acute complicated | Moderate 3 Categories OR 2 Tests | Moderate IV fluids, major surgery, hospitalization |
| High | 1 Chronic w/ exacerbation OR 2+ Undiagnosed new OR 1 Life-threatening | Extensive 4 Categories OR 3 Tests | High Life-threatening illness, emergency surgery |
Data Thresholds (Categories)
Counting Data
Category 1: Tests/Documents (Review of prior notes, external records) Category 2: Independent Historian (Family, caregiver, interpreter) Category 3: External Notes (Discussion with external provider)
| Level | Requirement |
|---|---|
| Minimal | 1 Category |
| Limited | 2 Categories |
| Moderate | 3 Categories OR 2 Unique Tests |
| Extensive | 4 Categories OR 3 Unique Tests |
Risk Levels Examples
| Risk Level | Examples |
|---|---|
| Minimal | Rest, fluids, OTC meds, minor injury |
| Low | Prescription meds, PT/OT, IV fluids (simple), minor surgery |
| Moderate | Major surgery (elective), Hospitalization, IV fluids (complex), Chemo |
| High | Life-threatening illness, Emergency major surgery, Drug therapy requiring intensive monitoring |
Quick Reference: Problem Types
| Type | Definition | Example |
|---|---|---|
| Self-Limited | Runs definite course, resolves | Common cold, minor sprain |
| Stable Chronic | No change, maintenance | Controlled HTN, stable DM |
| Acute Uncomplicated | New, limited severity | Simple UTI, sinusitis |
| Acute Complicated | New, systemic symptoms | Pneumonia, pyelonephritis |
| Undiagnosed New | Uncertain prognosis | New lump, new headache |
| Chronic Exacerbation | Worsening condition | COPD flare, CHF exacerbation |
Related: Inpatient E&M Codes E&M Coding for PhysiatristsM Coding for Physiatrists