Codes & Level of MDM | Capturing Social Determinants of Health Using Z Codes

Capturing Social Determinants of Health Using Z Codes

Clinicians will now choose the MDM E/M levels based on 3 broad criteria.

99202 or 99212 Straightforward:
Number and complexity of problems discussed at the encounter is 1 self-limited or minor problem. Amount and complexity of data reviewed and analyzed is minimal or none. Risk of complication and morbidity or mortality of patient management is minimal risk or morbidity from more diagnostic testing of treatment.
Number & complexity of problems discussed at the encounter	Amount & complexity of data reviewed & analyzed	Risk of complication & morbidity or mortality of patient management
1 self-limited or minor problem	Minimal or none	Minimal risk of morbidity from more diagnostic testing or treatment

99203 or 99213 Low:
Number and complexity of problems discussed at the encounter is 2 or more self-limited or minor problems, or 1 chronic illness or 1 acute illness or injury. Amount and complexity of data reviewed and analyzed is limited need for tests or assessments. Risk of complication and morbidity or mortality of patient management is low risk of morbidity from more diagnostic testing or treatment.
Number & complexity of problems discussed at the encounter	Amount & complexity of data reviewed & analyzed	Risk of complication & morbidity or mortality of patient management
2 or more self-limited or minor problems, or 1 chronic illness or 1 acute illness or injury	Limited need for tests or assessments	Low risk of morbidity from more diagnostic testing or treatment

99204 or 99214 Moderate:
Number and complexity of problems discussed at the encounter is 1 or more chronic illnesses with exacerbation or 2 or more stable chronic illnesses or 1 new diagnosis with uncertain prognosis. Amount and complexity of data reviewed and analyzed is moderate need for more tests or assessments, with discussion of management or test interpretation. Risk of complication and morbidity or mortality of patient management, with new criteria related to SDOH, is moderate risk of morbidity from more diagnostic testing or treatment, for example, diagnosis or treatment significantly limited by SDOH.
Number & complexity of problems discussed at the encounter	Amount & complexity of data reviewed & analyzed	New criteria related to SDOH: Risk of complication & morbidity or mortality of patient management
1 or more chronic illnesses with exacerbation or 2 or more stable chronic illnesses or 1 new diagnosis with uncertain prognosis	Moderate need for more tests or assessments; discussion of management or test interpretation	Moderate risk of morbidity from more diagnostic testing or treatment, for example, diagnosis or treatment significantly limited by SDOH

99205 or 99215 High:
Number and complexity of problems discussed at the encounter is 1 or more chronic illnesses with exacerbation or 2 or more stable chronic illnesses or 1 new diagnosis with uncertain prognosis. Amount and complexity of data reviewed and analyzed is extensive need for more tests or assessments, independent interpretation of tests, with discussion of management. Risk of complication and morbidity or mortality of patient management is high risk of morbidity from more diagnostic testing or treatment.
Number & complexity of problems discussed at the encounter	Amount & complexity of data reviewed & analyzed	Risk of complication & morbidity or mortality of patient management
1 or more chronic illnesses with exacerbation or 2 or more stable chronic illnesses or 1 new diagnosis with uncertain prognosis	Extensive need for more tests or assessments, independent interpretation of tests; discussion of management	High risk of morbidity from more diagnostic testing or treatment