Wiki 2021 number and complexity of problems in MDM

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In determining the number and complexity of problems with the new guidelines, we no longer count the problem points, right? The MDM guidelines don't really make this clear, IMO.

Evaluation and Management Code Changes 2021 - AAPC
The MDM guidelines and table are under Instructions for Selecting a Level of Office or Other Outpatient E/M Service, but you’ll use them together with information and definitions in Number and Complexity of Problems Addressed at the Encounter.
In the 2021 MDM guidelines, CPT® states that MDM “includes establishing diagnoses, assessing the status of a condition, and/or selecting a management option.” Three elements will define MDM for office/outpatient visits in 2021, and they are similar but not identical to the 2020 elements:
  • 1. The number and complexity of the problem or problems the provider addresses during the E/M encounter.
    • In 2020, the guidelines instead refer to “the number of possible diagnoses and/or the number of management options.”
  • 2. "The amount and/or complexity of data to be reviewed and analyzed.” The 2021 guidelines list 3 categories for data: (1) tests, documents, orders, or independent historians, (2) independent test interpretation, and (3) discussion of management or test interpretation with external providers or appropriate sources. The latter term refers to non-healthcare, non-family sources involved in patient management, like a parole officer or case manager.
    • The 2020 MDM guidelines also include the amount and/or complexity of medical records, test, and other information involved, but the 2021 guidelines expand the section significantly.
  • 3. "The risk of complications, morbidity, and/or mortality of patient management decisions made at the visit.” The 2021 guidelines make it clear that options considered, but not selected, are still a factor for this element, specifically after “shared” MDM with the patient, family, or both. Examples include deciding against hospitalization for a psychiatric patient with sufficient support for outpatient care or choosing palliative care for a patient with advanced dementia and an acute condition.
    • The 2020 MDM guidelines include comparable wording, but do not include the reference to shared MDM or the examples found in the 2021 guidelines.

 
You don't count problem points per se, but you still look at the type (acute/chronic), complexity (stable or not, uncertain or not, etc.), and number of each. See the MDM table on pages 16-17 of the AMA CPT code book.

Hope that helps!

Leesa A. Israel, BA, CPC, CUC, CEMC, CPPM, CMBS, AAPC MACRA Proficient
Head of Publishing, Editorial & Technology
AAPC
 
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