From what I remember reading about this (I'm going to try to find the documentation), the code is based on the doctor's recommendations, not on what the patient chose to do about it. So in the example you stated, if the doctor recommends a minor surgery with identified risk factors, the risk level is moderate, regardless of what the patient chooses, because the same data has to be reviewed to get to this conclusion in either case. If I can find this in black-and-white, I'll post it here for you
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