Office/Outpatient codes 99202–99215. Select encounter type, check what applies, and the tool computes the CPT® using the 2 of 3 rule.
History & Examination Document when performed
Number & Complexity of Problems Addressed
| Level | Problem status (select all that apply) | Select |
|---|---|---|
| Minimal | 1 self-limited/minor | |
| Low | 2+ self-limited/minor | |
| Low | 1 stable chronic | |
| Low | 1 acute, uncomplicated illness/injury | |
| Moderate | 1+ chronic illness with exacerbation, progression, or SEs | |
| Moderate | 2+ stable chronic illnesses | |
| Moderate | Undiagnosed new problem with uncertain prognosis / acute illness with systemic symptoms / acute complicated injury | |
| High | 1+ chronic illnesses with severe exacerbation/progression/SEs OR threat to life/function |
Examples
- Minimal: Viral URI, contact dermatitis.
- Low: Stable HTN/DM; acute uncomplicated cystitis; ankle sprain.
- Moderate: Worsening asthma; new anemia; pyelonephritis; concussion with brief LOC.
- High: CHF with acute decompensation; sepsis; chest pain with concerning features.
Amount and/or Complexity of Data
| Reviewed/Analyzed | Select | Count |
|---|---|---|
| Review of prior external note(s) from each unique source | ||
| Review of result(s) from each unique test | ||
| Ordering of each unique test | ||
| Assessment requiring an independent historian | — | |
| Independent interpretation of a test performed by another physician/QHP (not separately reported) | — | |
| Discussion of management or test interpretation with external physician/QHP/appropriate source (not separately reported) | — |
Examples & Scoring Tips
- Low (Limited): Any 2 Cat.1 items (e.g., 1 external note + 1 test ordered).
- Moderate: Any 3 Cat.1 items or Cat.2 or Cat.3.
- High (Extensive): Any 2 of {Cat.1 ≥ 3, Cat.2, Cat.3}.
- Unique tests counted once per code (CBC + CMP = 2).
Risk of Patient Management
| Level | Examples | Select |
|---|---|---|
| Minimal | Minimal risk of morbidity from additional diagnostic testing or treatment | |
| Low | Low risk of morbidity from additional diagnostic testing or treatment | |
| Moderate |
| |
| High |
|
Quick Examples
- Low: Simple wound care; OTC meds.
- Moderate: Start/adjust antihypertensive; elective laparoscopy without RF.
- High: Admit for GI bleed; chemotherapy with intensive monitoring.
MDM Result
| Component | Minimal | Low | Moderate | High |
|---|---|---|---|---|
| Problems | ||||
| Data | ||||
| Risk | ||||
| Overall MDM | — | |||
Calculated Level of Service: N/A
Code map: New 99202/3/4/5 • Established 99212/3/4/5 (by SF/Low/Mod/High).
Note: 99211 is not MDM/time-based; reflects clinical staff services under supervision.
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