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99254 moderate complexity?

  1. #1
    Default 99254 moderate complexity?
    Medical Coding Books
    I need help defining e/m decision making! what constitutes moderate, or low complexity?? I can't find this anywhere.

    The cases in question is I/P consult where decision for surgery was made. What type of complexity is this????

    Help would be greatly appreciated. L

  2. #2

    Hopefully this will be helpful to you. The risk table, which is the same for both 95 and 97 guidelines is on page 24.

    To determine your MDM level it is actually 2 of 3. So your level of at least 2 of the 3 (Dx points, Data points, Risk) must meet or exceed the level in order to support it.

    On the table of risk you pick the highest of any category. So treatment options, ie surgery, are in the far right column.

    In order to give you a MDM level we really need more information. It is not cut and dry based on surgery options.

    What dx do you have and are they new, established stable, or established worsening?

    What data is being reviewed/ordered?

    What type of surgery?

    Laura, CPC, CEMC

  3. #3
    Laura thank you so very much. I can always count on valid help from my fellow AAPCers.

    Bless you. L

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