Evaluation and Management Services- Selecting a Code based on Medical Decision Making
In 2021, office and outpatient Evaluation and Management Services are selected based on either time or medical decision making. As a reminder, to choose the appropriate CPT code based on medical decision making, two of three elements of medical decision must be met or exceeded:
- Number and Complexity of Problems Addressed
- Amount and/or Complexity of Data to be Reviewed and Analyzed
- Risk of Complications and/or Morbidity or Mortality of Patient Management
Be sure to refer to the American Medical Association’s Medical Decision Making table to understand the criteria for code level selection. In addition, updates have been made to the Office or Other Outpatient and Prolonged Services Code and Guideline Changes to provide clarification on the terms and definitions within the table.
Questions regarding Evaluation and Management Services (or any other billing and coding inquiries) can be sent to ASCO staff at firstname.lastname@example.org.