Mdm Risk Table

For 2021, the titles of these three MDM elements have been revised to better reflect the medical decision making process. The table below highlights the revisions to the MDM elements titles effective January 1, 2021, for office/outpatient E/M codes. The level of MDM for office/outpatient E/Ms continues to be based on 2 out of 3 elements. Prior ...

The MDM table of risk takes into account the risk of complications, morbidity, and mortality based on the patient’s condition. Use the highest level of risk based on ONE element from ANY of the categories below. The highest level determines the overall risk. Requires ONE of these elements in ANY of the three categories (presenting problem (s ...

Risk of Complications and/or Morbidity or Mortality of Patient Management. Use the risk table below as a guide to assign risk factors. It is understood that the table below does not contain all specific instances of medical care; the table is intended to be used as a guide. Select the most appropriate factor(s) in each category.

Risk: The probability and/or consequences of an event. 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 MDM, level of risk is based upon consequences of the problem(s) addressed at the encounter when appropriately treated.

The 2021 MDM table references SDOH in an example of moderate risk from additional diagnostic testing or treatment because SDOH, like housing insecurity, may limit those options. Drug therapy requiring intensive monitoring for toxicity is in the 2021 CPT ® MDM table as an example of high risk of morbidity from additional diagnostic testing or ...