About the E/M Medical Decision Making (MDM) Level Calculator
Physicians, coders, auditors, and compliance teams use an E/M MDM level calculator to map office and outpatient evaluation and management visits to straightforward, low, moderate, or high medical decision making. It applies the AMA two-of-three framework across problems addressed, data reviewed or analyzed, and patient management risk.
How it works
- Select the number and complexity of problems addressed.
- Add the amount or complexity of data reviewed, ordered, interpreted, or discussed.
- Choose the risk level for management decisions made during the encounter.
- Review the MDM level reached by at least two of the three elements.
- Map the level to the appropriate office or outpatient CPT code family when applicable.
Frequently asked questions
How is E/M MDM level determined for office visits?
For the 2021 office and outpatient framework, the level is based on two of three elements: problems addressed, data, and risk of complications or management.
Does documenting more history automatically raise the MDM level?
No. History and exam should be medically appropriate, but they do not determine the office and outpatient code level under the 2021 MDM framework.
What counts as data in E/M medical decision making?
Data may include tests ordered or reviewed, independent interpretation, review of external notes, use of an independent historian, or discussion with another qualified professional, depending on AMA definitions.
Can time be used instead of MDM for office E/M coding?
Yes, when the code family permits it and total time is documented according to CPT rules. Do not mix time and MDM unless the coding guidance allows the selected method.
References
- AMA CPT Evaluation and Management Services Guidelines - 2021 office and outpatient MDM framework
- CMS Medicare Claims Processing Manual - evaluation and management coding and documentation
- AMA CPT code set 99202-99215 - office or other outpatient E/M services