2021 Medical Decision Making Risk Table

The Level of Medical Decision Making table is to be used as a guide to assist in selecting the level of medical decision making for reporting an office or other outpatient E/M service code. The table includes the four levels of medical decision making (straightforward, low, moderate and high) and the three elements of medical decision making (number and complexity of problems addressed, amount and/or complexity of data reviewed and analyzed, and risk of complications and/or morbidity or mortality of patient management).*

You may switch between the current MDM criteria and 2021 MDM criteria by selecting the buttons labeled as such. Within the 2021 MDM section, quick clicks are available in lieu of completing the table; however, if the level is not known a suggested code can be produced by completing the table.

The risk table is divided into three elements:

• Number and Complexity of Problems Addressed
• Amount and/or Complexity of Data to be Reviewed and Analyzed
• Risk of Complications and/or Morbidity or Mortality of Patient Management

Two of the three elements must be complete in order to have considered MDM in an audit. As each section is completed, Audit Manager will suggest a code based on the new criteria. This code is also considered the 2021 code used in final reports.

For more details on each element, visit the application and review tool tips where they are available or you may reference the original AMA table here.

*CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes