II. Decision Making Type: Straightforward

  1. Criteria
    1. Minimal number of diagnoses or management options
    2. Minimal or no data to be reviewed
    3. Minimal risk of complications, morbidity, mortality
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99201
      2. CPT 99202
    2. E/M Established Outpatient Visit
      1. CPT 99212
    3. E/M Emergency Services
      1. CPT 99281
    4. E/M Consultation Services
      1. CPT 99241
      2. CPT 99242

III. Decision Making Type: Low Complexity

  1. Criteria
    1. Limited number of diagnoses or management options
    2. Limited amount or complexity of data to be reviewed
    3. Low risk of complications, morbidity, mortality
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99203
    2. E/M Established Outpatient Visit
      1. CPT 99213
    3. E/M Emergency Services
      1. CPT 99282
    4. E/M Consultation Services
      1. CPT 99243

IV. Decision Making Type: Moderate Complexity

  1. Criteria
    1. Multiple diagnoses or management options
    2. Moderate amount or complexity of data to be reviewed
    3. Moderate risk of complications, morbidity, mortality
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99204
    2. E/M Established Outpatient Visit
      1. CPT 99214
    3. E/M Emergency Services
      1. CPT 99283
      2. CPT 99284
    4. E/M Consultation Services
      1. CPT 99244

V. Decision Making Type: High Complexity

  1. Criteria
    1. Extensive diagnoses or management options
    2. Extensive amount or complexity of data to be reviewed
    3. High risk of complications, morbidity, mortality
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99205
    2. E/M Established Outpatient Visit
      1. CPT 99215
    3. E/M Emergency Services
      1. CPT 99285
    4. E/M Consultation Services
      1. CPT 99245

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