Wiki 2023 MDM TABLE

[emmaflattery]

Can anyone clarify something for me about the MDM table?
Do we have to use all three columns or just two? I'm finding that none of my providers are hitting all bullets with the elements of MDM.
Is it true you can also use risk of complications and number of complexity of problems addressed at the encounter to reach your level?
thanks in advance.

Emma
emma.flattery@gmail.com

 

[jkyles]

Hi there,
Do you have the 2023 CPT manual? The upper left square of the MDM chart in the manual states:

Level of MDM (Based on 2 out of 3 Elements of MDM)

 

[emmaflattery]

Thank you for your reply but I'm still a little confused. In the center column where it says must meet the requirements, etc, that has to be all of what is in the bullet correct and if they don't meet it the charge would be dropped to a lower code? I'm sorry for the confusion I just want to be certain. I've been told if you don't meet anything in column 2 then you can use column 1 and 3 to get your level. I guess what I'm trying to ask is if we have to choose something from each column?
Thanks again.

 

[stosadori@legacytreatment.org]

I believe there is still a N/A or Minimal/None option for the second column that you can choose.

 

[jkyles]

Thank you for your reply but I'm still a little confused. In the center column where it says must meet the requirements, etc, that has to be all of what is in the bullet correct and if they don't meet it the charge would be dropped to a lower code? I'm sorry for the confusion I just want to be certain. I've been told if you don't meet anything in column 2 then you can use column 1 and 3 to get your level. I guess what I'm trying to ask is if we have to choose something from each column?
Thanks again.

Got it.
1. No, you do not have to select an item from each column for MDM. For example, if the provider documents moderate complexity of problem and moderate risk, and no data review, that's moderate MDM
2. The center column you're referring to is just for the data review element. For example, moderate review contains three categories with different requirements. You must hit all of the requirements for at least one of the review categories to score a moderate review.