Wiki Something I just noticed about AAPC's E&M Calculator for 2021

[carlystur]

Their Medical Decision Making section is only the Table of Risk and nothing else. The points for Number of Diagnoses/Management Options aren't included. So, the Established problem worsening/stable/improved and New problem with/out additional workup planned aren't there. Nor are the points for Amount and/or Complexity of Data Reviewed. Meaning the decision to obtain old record and/or obtain history from someone other than the patient, etc. I used to choose my office e/m levels based solely on the Table of Risk and I believe that can get you to too high a level if the other two things do not support it from what's stated in that date's documentation. Check a normal Medical Decision Making Table and it should show all of that, not just the table of risk. Something like this, for example.

Is this odd to anyone else or am I missing something and the rest of it isn't actually needed to level an office outpatient visit?

 

[ckeeney]

Review the guideline updates that went into effect for 2021 for the Office Visit CPT codes (99202-99215). There were substantial changes. It appears that you may be trying to code the levels based on the pre-2021 guidelines. I use the AAPC audit sheet almost every day and find it accurate.

 

[csperoni]

Their Medical Decision Making section is only the Table of Risk and nothing else. The points for Number of Diagnoses/Management Options aren't included. So, the Established problem worsening/stable/improved and New problem with/out additional workup planned aren't there. Nor are the points for Amount and/or Complexity of Data Reviewed. Meaning the decision to obtain old record and/or obtain history from someone other than the patient, etc. I used to choose my office e/m levels based solely on the Table of Risk and I believe that can get you to too high a level if the other two things do not support it from what's stated in that date's documentation. Check a normal Medical Decision Making Table and it should show all of that, not just the table of risk. Something like this, for example.

Is this odd to anyone else or am I missing something and the rest of it isn't actually needed to level an office outpatient visit?

I was curious, so I just went to the tool myself. When I entered outpatient, established & 2022 date of service, the entire MDM came up: Problem, Data, and Risk. See my screen shot below. I'm not sure where you are seeing risk only.
Any E/M tool leveling MDM with risk only would definitely be incorrect, regardless of date of service or location. The date of service and location do determine what comprises MDM.
For outpatient starting 2021, your MDM is made up of 2 of 3 on problem, data, and risk.
Hope that helps!

 

[carlystur]

I was curious, so I just went to the tool myself. When I entered outpatient, established & 2022 date of service, the entire MDM came up: Problem, Data, and Risk. See my screen shot below. I'm not sure where you are seeing risk only.
Any E/M tool leveling MDM with risk only would definitely be incorrect, regardless of date of service or location. The date of service and location do determine what comprises MDM.
For outpatient starting 2021, your MDM is made up of 2 of 3 on problem, data, and risk.
Hope that helps!

Let me clarify what I meant by Table of Risk with the attached screenshot called Table of Risk. I had been using the other screenshot to code office visits when my co-worker was talking about the other stuff on it with our revenue cycle manager in our meeting a couple of months ago. I have definitely started using AAPC's 2021 E&M Calculator ever since I remembered it was there just a week or two ago.