Number and Amount and/or Complexity of Data to Risk of Complications

Complexity of be Reviewed and Analyzed and/or Morbidity or

Problems *Each unique test, order, or document Mortality of Patient
Addressed at contributes to the combination of 2 or Management
the Encounter combination of 3 in Category 1 below.

99211 N/A N/ A N/A N/A

99202 Straightforward Minimal Minimal or non Minimal risk

99212
*1 self-limited of morbidity from
or minor additional diagnostic
problem testing or treatment
99203 Low Low Limited Low risk
99213

*2 or more self- (Must meet the requirements of at of morbidity from

limited or minor least 1 of the 2 categories) additional diagnostic
problems; testing or treatment
Category 1: Tests and documents
or Any combination of 2 from the
*1 stable, following:
chronic *Review of prior external note(s)
illness; from each unique source*;

or *Review of the result(s) of each

*1 acute, unique test*;
uncomplicated
illness or injury *Ordering of each unique test*
Or

Category 2: Assessment
requiring an independent
historian(s)
(For the categories of
Independent interpretation of tests
and discussion of management or
test interpretation, see moderate or
high)

[1]
99204 Moderate Moderate Moderate Moderate risk of
99214 morbidity from
additional diagnostic
testing or treatment

*1 or more (Must meet the requirements of at Examples only:

chronic least 1 out of 3 categories)
illnesses with #Prescription drug
exacerbation, Category 1: Tests, documents, or management
progression, independent historian(s)
or side effects Any combination of 3 #Decision regarding
of treatment; from the following: minor surgery with
*Review of prior identified
or external note(s) from each unique patient or procedure risk
source*; factors
*2 or more *Review of the result(s) of each
stable, unique test*; #Decision regarding
chronic *Ordering of each unique test*; elective major surgery
illnesses; *Assessment requiring without identified patient
an independent historian(s) or procedure risk factors
or
or #Diagnosis or treatment
*1 undiagnosed Significantly limited by
new problem Category 2: Independent Social determinants of
with uncertain interpretation of tests health
prognosis; Independent interpretation of a test
performed by another
or physician/other qualified health
care professional (not separately
*1 acute illness reported);
with systemic
symptoms; Or

or Category 3: Discussion of
management or test
*1 acute, interpretation
complicated Discussion of management or test
injury interpretation with external
physician/other qualified health
care professional/appropriate
source (not separately
reported).

[2]
99205 High High Extensive High risk of morbidity
99215 from additional
diagnostic
testing or treatment

*1 or more (Must meet the Examples only:

chronic requirements of at least 2
illnesses with out of 3 categories) #Drug therapy requiring
severe Intensive monitoring for
exacerbation, Category 1: Tests, Toxicity
progression, documents, or
or side effects independent historian(s)
of treatment; Any combination of 3 #Decision regarding
from the following: elective major surgery
or with identified patient or
*Review of prior external note(s) procedure risk factors
*1 acute or from each unique source*;
chronic *Review of the result(s) of each #Decision regarding
illness or unique test*; Emergency major surgery
injury that *Ordering of each unique test*;
poses a threat *Assessment requiring an #Decision regarding
to life or independent historian(s) Hospitalization
bodily
function or #Decision not to
resuscitate or to
Category 2: Independent deescalate Care because
interpretation of tests of poor prognosis
Independent
interpretation of a test
performed by another
physician/other
qualified health care
professional (not
separately reported);

or

Category 3: Discussion
of management or test
interpretation
Discussion of management or test
interpretation with external
physician/other qualified health
care professional/appropriate
source (not separately
reported)

[3]