Risk of Complications/Morbidity/Mortality:
| New | 99201** | 99202 | 99203 | 99204 | 99205 |
| Established | 99211 | 99212 | 99213 | 99214 | 99215 |
| Diagnoses or Management Problems | One Self-limited or minor problem | Two or more self-limited or minor problems One stable chronic condition Acute uncomplicated illness (e.g., allergic rhinitis, simple sprain | One or more chronic illnesses with complications Two or more stable chronic illnesses Undiagnosed new problem w/ uncertain prognoses Acute illness with systemic symptoms Acute complicated injury | One or more chronic illness withsevere complications Acute or chronic illness or injury that is life or limb threatening Abrupt change in neurologic status | |
| Diagnostic Procedures | Lab X-ray EKG UA Ultrasound, etc Venipuncture KOH. | Physiologic tests not under stress Pulmonary Function Barium enema Arterial puncture Skin biopsies | Physiologic tests under stress – cardiac stress test Diagnostic endoscopies with no risk factors Deep needle or incisional biopsy Obtained fluid from body Cardiovascular imaging with contrast | Cardiovascular imaging with contrast Invasive diagnostic tests Cardiac electrophysiological tests Diagnostic endoscopies w/ identified risk factors Discography | |
| Treatment of Management Options | Rest Gargles Elastic bandages Dressings | OTCs Minor surgery w/ no identified risk factors PT OT IVs without additives | Minor surgery with risk factors Elective major surgery – no risk factors Prescription drug management IV fluids with additives Closed fracture or dislocation treatment w/o manipulation Therapeutic nuclear medicine | Elective surgery with identified risk factors Emergency major surgery Parenteral controlled substances Drug treatment requiring intensive monitoring Decisions not to resuscitate or de-escalate care because of poor prognosis |
** For a new patient 99201, use the requirements for a new patient 99202 Coding Requirements: The highest level of risk in any one column determines the overall risk. If there is not an item in documented in each one of the Presenting Problem, Amount/Complexity of Data, and Risk of Complications/Morbidity/Mortality you, are not eligible for a level beyond 99202.
