Code E/M
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About
- High
- Presenting Problem(s)
One (1) or more chronic illnesses with severe excerbation, progression, or side effects of treatment.
Acute or chronic illness or injuries which pose a threat to life or bodily function (e.g., multiple trauma, acute MI, pulmonary embolism, severe respiratory distress, progressive severe rheumatoid arthritis, psychiatric illness with potential threat to self or others, peritonitis, acute renal failure).
Diagnostic Procedure(s) Ordered
Cardiovascular imaging studies with contract with identified risk factors.
Cardiac EP testing.
Diagnostic endoscopies with identified risk factors.
Discography.
Management Options Selected
Elective major surgery (open percutaneous or endoscopic) with identified risk factors.
Emergency major surgery.
Parenteral controlled substances.
Drug therapy requiring intensive monitoring for toxicity.
Decision not to resuscitate or to de-escalate care because of poor prognosis.
- Moderate
- Presenting Problem(s)
One (1) or more chronic illnesses with mild exacerbation, progression, or side effects of treatment.
Two or more stable chronic illnesses.
Undiagnosed new problem with uncertain prognosis (e.g., lump in breast).
Acute illness with systemic symptoms (e.g., pyelonephritis, pneumonitis, colitis).
Acute complicated injury (e.g., head injury with brief loss of consciousness).
Diagnostic Procedure(s) Ordered
Physiologic tests not under stress, eg. pulmonary function tests, fetal contractions stress test.
Diagnostic endoscopies with no identified risk factors.
Deep needle or incisional biopsies.
Cardiovascular imaging studies with contrast and no identified risk factors (e.g., arteriogram, cardiac catheterization).
Obtain fluid from body cavity (e.g., LP, thoracentesis, culdocentesis).
Management Options Selected
Minor surgery with identified risk factors.
Elective major surgery with no risk factors.
Prescription drug management.
Therapeutic nuclear medicine.
IV fluids with additives.
Closed treatment of fracture or dislocations without manipulation.
Developed by EM Code Services
V. Siemion, M.D.
Version 1.3
Email: info@emcodeservices.com
Legal disclaimer
This software is designed and intended to serve as a point of care reference tool for evaluation and management coding guidelines. The information in this software is intended for quick identification of an appropriate Current Procedural Terminology (CPT) evaluation and management (E/M) code or range of codes to report the service provided. This software is not intended to replace the judgment of the individual in selection of an appropriate level of E/M service and CPT code. The authors have used currently available data in the software. The data is subject to change. The authors make no claims of the accuracy of the data contained herein. By using this software you agree that you will not hold the authors liable for any damages that may occur through the use of this software.
TrailBlazer (Medicare Part B carrier for Delaware, Maryland and Texas) has developed its own Medical Decision Making system.
This program uses the 1997 E/M Coding Guidelines and the latest 2011 RVU and GCPI locality pricing data from CMS.
Copyright © 2011 EM Code Services
|
OVERALL MDM
|
PROBLEM POINTS
|
DATA POINTS
|
RISK
|
|
Straightforward
|
=1
|
=1
|
Minimal
|
|
Low
|
2
|
2
|
Low
|
|
Moderate
|
3
|
3
|
Moderate
|
|
High
|
=4
|
=4
|
High
|
99201
office/outpatient visit new
a
0.48
0.69
0.73
0.24
0.26
0.04
1.21
1.25
0.76
0.78
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99202
office/outpatient visit new
a
0.93
1.09
1.16
0.44
0.49
0.07
2.09
2.16
1.44
1.49
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99203
office/outpatient visit new
a
1.42
1.47
1.57
0.64
0.72
0.14
3.03
3.13
2.2
2.28
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99204
office/outpatient visit new
a
2.43
2
2.14
1.06
1.2
0.23
4.66
4.8
3.72
3.86
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99205
office/outpatient visit new
a
3.17
2.36
2.51
1.34
1.49
0.27
5.8
5.95
4.78
4.93
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99211
office/outpatient visit est
a
0.18
0.39
0.37
0.08
0.08
0.01
0.58
0.56
0.27
0.27
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99212
office/outpatient visit est
a
0.48
0.7
0.72
0.22
0.24
0.04
1.22
1.24
0.74
0.76
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99213
office/outpatient visit est
a
0.97
0.99
1.05
0.41
0.47
0.07
2.03
2.09
1.45
1.51
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99214
office/outpatient visit est
a
1.5
1.41
1.48
0.63
0.71
0.1
3.01
3.08
2.23
2.31
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99215
office/outpatient visit est
a
2.11
1.8
1.9
0.9
1
0.14
4.05
4.15
3.15
3.25
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99217
observation care discharge
a
1.28
0.68
na
0.73
na
0.68
0.73
0.08
2.04
2.09
2.04
2.09
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99218
initial observation caree
a
1.28
0.53
na
0.58
na
0.53
0.58
0.08
1.89
1.94
1.89
1.94
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99219
initial observation care
a
2.14
0.88
na
0.98
na
0.88
0.98
0.14
3.16
3.26
3.16
3.26
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99220
initial observation care
a
2.99
1.23
na
1.34
na
1.23
1.34
0.2
4.42
4.53
4.42
4.53
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99221
initial hospital care
a
1.92
0.76
na
0.86
na
0.76
0.86
0.18
2.86
2.96
2.86
2.96
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99222
initial hospital care
a
2.61
1.06
na
1.2
na
1.06
1.2
0.22
3.89
4.03
3.89
4.03
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99223
initial hospital care
a
3.86
1.56
na
1.77
na
1.56
1.77
0.29
5.71
5.92
5.71
5.92
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99224
subsequent observation care
a
0.54
0.24
na
0.24
na
0.24
0.24
0.04
0.82
0.82
0.82
0.82
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99225
subsequent observation care
a
0.96
0.44
na
0.44
na
0.44
0.44
0.05
1.45
1.45
1.45
1.45
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99226
subsequent observation care
a
1.44
0.65
na
0.65
na
0.65
0.65
0.08
2.17
2.17
2.17
2.17
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99231
subsequent hospital care
a
0.76
0.32
na
0.34
na
0.32
0.34
0.05
1.13
1.15
1.13
1.15
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99232
subsequent hospital care
a
1.39
0.57
na
0.63
na
0.57
0.63
0.08
2.04
2.1
2.04
2.1
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99233
subsequent hospital care
a
2
0.81
na
0.9
na
0.81
0.9
0.12
2.93
3.02
2.93
3.02
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99234
observ/hosp same date
a
2.56
1.09
na
1.16
na
1.09
1.16
0.22
3.87
3.94
3.87
3.94
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99235
observ/hosp same date
a
3.41
1.43
na
1.55
na
1.43
1.55
0.23
5.07
5.19
5.07
5.19
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99236
observ/hosp same date
a
4.26
1.75
na
1.89
na
1.75
1.89
0.29
6.3
6.44
6.3
6.44
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99238
hospital discharge day
a
1.28
0.68
na
0.74
na
0.68
0.74
0.07
2.03
2.09
2.03
2.09
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99239
hospital discharge day
a
1.9
0.97
na
1.09
na
0.97
1.09
0.11
2.98
3.1
2.98
3.1
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99241
office consultation
i
+
0.64
0.66
0.66
0.24
0.24
0.07
1.37
1.37
0.95
0.95
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99242
office consultation
i
+
1.34
1.1
1.1
0.51
0.51
0.14
2.58
2.58
1.99
1.99
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99243
office consultation
i
+
1.88
1.46
1.46
0.71
0.71
0.18
3.52
3.52
2.77
2.77
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99244
office consultation
i
+
3.02
1.96
1.96
1.14
1.14
0.22
5.2
5.2
4.38
4.38
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99245
office consultation
i
+
3.77
2.3
2.3
1.38
1.38
0.29
6.36
6.36
5.44
5.44
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99251
inpatient consultation
i
+
1
0.32
na
0.32
na
0.32
0.32
0.07
1.39
1.39
1.39
1.39
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99252
inpatient consultation
i
+
1.5
0.52
na
0.52
na
0.52
0.52
0.12
2.14
2.14
2.14
2.14
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99253
inpatient consultation
i
+
2.27
0.84
na
0.84
na
0.84
0.84
0.15
3.26
3.26
3.26
3.26
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99254
inpatient consultation
i
+
3.29
1.23
na
1.23
na
1.23
1.23
0.18
4.7
4.7
4.7
4.7
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99255
inpatient consultation
i
+
4
1.44
na
1.44
na
1.44
1.44
0.24
5.68
5.68
5.68
5.68
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99281
emergency dept visit
a
0.45
0.13
na
0.14
na
0.13
0.14
0.03
0.61
0.62
0.61
0.62
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99282
emergency dept visit
a
0.88
0.24
na
0.27
na
0.24
0.27
0.07
1.19
1.22
1.19
1.22
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99283
emergency dept visit
a
1.34
0.36
na
0.39
na
0.36
0.39
0.1
1.8
1.83
1.8
1.83
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99284
emergency dept visit
a
2.56
0.62
na
0.67
na
0.62
0.67
0.22
3.4
3.45
3.4
3.45
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99285
emergency dept visit
a
3.8
0.88
na
0.91
na
0.88
0.91
0.3
4.98
5.01
4.98
5.01
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99288
direct advanced life support
b
0
0
0
0
0
0
0
0
0
0
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99291
critical care first hour
a
4.5
2.94
3.02
1.55
1.67
0.34
7.78
7.86
6.39
6.51
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99292
critical care addl 30 min
a
2.25
1.07
1.12
0.78
0.84
0.18
3.5
3.55
3.21
3.27
0
zzz
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99304
nursing facility care init
a
1.64
0.81
0.94
0.81
0.94
0.14
2.59
2.72
2.59
2.72
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99305
nursing facility care init
a
2.35
1.09
1.27
1.09
1.27
0.2
3.64
3.82
3.64
3.82
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99306
nursing facility care init
a
3.06
1.34
1.58
1.34
1.58
0.23
4.63
4.87
4.63
4.87
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99307
nursing fac care subseq
a
0.76
0.44
0.49
0.44
0.49
0.04
1.24
1.29
1.24
1.29
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99308
nursing fac care subseq
a
1.16
0.68
0.76
0.68
0.76
0.07
1.91
1.99
1.91
1.99
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99309
nursing fac care subseq
a
1.55
0.88
0.99
0.88
0.99
0.08
2.51
2.62
2.51
2.62
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99310
nursing fac care subseq
a
2.35
1.23
1.41
1.23
1.41
0.14
3.72
3.9
3.72
3.9
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99315
nursing fac discharge day
a
1.13
0.61
0.69
0.61
0.69
0.07
1.81
1.89
1.81
1.89
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99316
nursing fac discharge day
a
1.5
0.77
0.87
0.77
0.87
0.08
2.35
2.45
2.35
2.45
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99318
annual nursing fac assessmnt
a
1.71
0.84
0.98
0.84
0.98
0.1
2.65
2.79
2.65
2.79
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99324
domicil/r-home visit new pat
a
1.01
0.54
0.54
0.54
na
0.54
na
0.07
1.62
1.62
1.62
1.62
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99325
domicil/r-home visit new pat
a
1.52
0.72
0.72
0.72
na
0.72
na
0.1
2.34
2.34
2.34
2.34
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99326
domicil/r-home visit new pat
a
2.63
1.18
1.31
1.18
na
1.31
na
0.16
3.97
4.1
3.97
4.1
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99327
domicil/r-home visit new pat
a
3.46
1.54
1.74
1.54
na
1.74
na
0.22
5.22
5.42
5.22
5.42
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99328
domicil/r-home visit new pat
a
4.09
1.77
1.99
1.77
na
1.99
na
0.24
6.1
6.32
6.1
6.32
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99334
domicil/r-home visit est pat
a
1.07
0.58
0.62
0.58
na
0.62
na
0.07
1.72
1.76
1.72
1.76
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99335
domicil/r-home visit est pat
a
1.72
0.84
0.94
0.84
na
0.94
na
0.1
2.66
2.76
2.66
2.76
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99336
domicil/r-home visit est pat
a
2.46
1.15
1.31
1.15
na
1.31
na
0.14
3.75
3.91
3.75
3.91
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99337
domicil/r-home visit est pat
a
3.58
1.59
1.83
1.59
na
1.83
na
0.23
5.4
5.64
5.4
5.64
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99339
domicil/r-home care supervis
b
+
1.25
0.91
0.91
0.91
na
0.91
na
0.08
2.24
2.24
2.24
2.24
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99340
domicil/r-home care supervis
b
+
1.8
1.22
1.22
1.22
na
1.22
na
0.12
3.14
3.14
3.14
3.14
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99341
home visit new patient
a
1.01
0.53
0.52
0.53
na
0.52
na
0.07
1.61
1.6
1.61
1.6
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99342
home visit new patient
a
1.52
0.71
0.7
0.71
na
0.7
na
0.11
2.34
2.33
2.34
2.33
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99343
home visit new patient
a
2.53
1.11
1.15
1.11
na
1.15
na
0.18
3.82
3.86
3.82
3.86
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99344
home visit new patient
a
3.38
1.53
1.74
1.53
na
1.74
na
0.22
5.13
5.34
5.13
5.34
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99345
home visit new patient
a
4.09
1.81
2.05
1.81
na
2.05
na
0.26
6.16
6.4
6.16
6.4
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99347
home visit est patient
a
1
0.53
0.55
0.53
na
0.55
na
0.07
1.6
1.62
1.6
1.62
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99348
home visit est patient
a
1.56
0.76
0.8
0.76
na
0.8
na
0.1
2.42
2.46
2.42
2.46
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99349
home visit est patient
a
2.33
1.11
1.26
1.11
na
1.26
na
0.14
3.58
3.73
3.58
3.73
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99350
home visit est patient
a
3.28
1.49
1.69
1.49
na
1.69
na
0.22
4.99
5.19
4.99
5.19
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99354
prolonged service office
a
1.77
0.93
1
0.75
0.81
0.11
2.81
2.88
2.63
2.69
0
zzz
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99355
prolonged service office
a
1.77
0.9
0.96
0.72
0.78
0.11
2.78
2.84
2.6
2.66
0
zzz
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99356
prolonged service inpatient
a
1.71
0.75
na
0.85
na
0.75
0.85
0.11
2.57
2.67
2.57
2.67
0
zzz
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99357
prolonged service inpatient
a
1.71
0.76
na
0.85
na
0.76
0.85
0.11
2.58
2.67
2.58
2.67
0
zzz
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99358
prolong service w/o contact
b
+
2.1
0.93
0.96
0.93
0.96
0.14
3.17
3.2
3.17
3.2
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99359
prolong serv w/o contact add
b
+
1
0.46
0.47
0.46
0.47
0.07
1.53
1.54
1.53
1.54
9
zzz
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99360
physician standby services
x
+
1.2
0.51
na
0.53
na
0.51
0.53
0.08
1.79
1.81
1.79
1.81
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99363
anticoag mgmt init
b
+
1.65
1.89
1.86
0.7
0.72
0.11
3.65
3.62
2.46
2.48
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99364
anticoag mgmt subseq
b
+
0.63
0.57
0.57
0.27
0.28
0.04
1.24
1.24
0.94
0.95
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99366
team conf w/pat by hc pro
b
+
0.82
0.37
0.38
0.35
0.36
0.05
1.24
1.25
1.22
1.23
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99367
team conf w/o pat by phys
b
+
1.1
0.47
na
0.48
na
0.47
0.48
0.07
1.64
1.65
1.64
1.65
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99368
team conf w/o pat by hc pro
b
+
0.72
0.3
na
0.32
na
0.3
0.32
0.04
1.06
1.08
1.06
1.08
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99374
home health care supervision
b
+
1.1
0.85
0.85
0.47
0.48
0.07
2.02
2.02
1.64
1.65
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99375
home health care supervision
i
+
1.73
1.28
1.19
0.88
0.76
0.11
3.12
3.03
2.72
2.6
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99377
hospice care supervision
b
+
1.1
0.85
0.85
0.47
0.48
0.07
2.02
2.02
1.64
1.65
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99378
hospice care supervision
i
+
1.73
1.34
1.19
0.94
0.76
0.11
3.18
3.03
2.78
2.6
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99379
nursing fac care supervision
b
+
1.1
0.85
0.85
0.47
0.48
0.07
2.02
2.02
1.64
1.65
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99380
nursing fac care supervision
b
+
1.73
1.19
1.19
0.75
0.76
0.11
3.03
3.03
2.59
2.6
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99381
init pm e/m new pat inf
n
+
1.19
1.49
1.42
0.51
0.52
0.08
2.76
2.69
1.78
1.79
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99382
init pm e/m new pat 1-4 yrs
n
+
1.36
1.55
1.49
0.59
0.6
0.08
2.99
2.93
2.03
2.04
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99383
prev visit new age 5-11
n
+
1.36
1.54
1.48
0.59
0.6
0.08
2.98
2.92
2.03
2.04
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99384
prev visit new age 12-17
n
+
1.53
1.61
1.56
0.66
0.67
0.1
3.24
3.19
2.29
2.3
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99385
prev visit new age 18-39
n
+
1.53
1.61
1.56
0.66
0.67
0.1
3.24
3.19
2.29
2.3
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99386
prev visit new age 40-64
n
+
1.88
1.77
1.71
0.81
0.82
0.12
3.77
3.71
2.81
2.82
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99387
init pm e/m new pat 65+ yrs
n
+
2.06
1.96
1.9
0.89
0.9
0.14
4.16
4.1
3.09
3.1
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99391
per pm reeval est pat inf
n
+
1.02
1.24
1.22
0.44
0.45
0.07
2.33
2.31
1.53
1.54
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99392
prev visit est age 1-4
n
+
1.19
1.32
1.3
0.51
0.52
0.08
2.59
2.57
1.78
1.79
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99393
prev visit est age 5-11
n
+
1.19
1.31
1.29
0.51
0.52
0.08
2.58
2.56
1.78
1.79
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99394
prev visit est age 12-17
n
+
1.36
1.38
1.36
0.59
0.6
0.08
2.82
2.8
2.03
2.04
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99395
prev visit est age 18-39
n
+
1.36
1.39
1.37
0.59
0.6
0.08
2.83
2.81
2.03
2.04
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99396
prev visit est age 40-64
n
+
1.53
1.46
1.44
0.66
0.67
0.1
3.09
3.07
2.29
2.3
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99397
per pm reeval est pat 65+ yr
n
+
1.71
1.66
1.64
0.74
0.75
0.11
3.48
3.46
2.56
2.57
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99401
preventive counseling indiv
n
+
0.48
0.55
0.52
0.21
0.21
0.03
1.06
1.03
0.72
0.72
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99402
preventive counseling indiv
n
+
0.98
0.78
0.74
0.42
0.43
0.07
1.83
1.79
1.47
1.48
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99403
preventive counseling indiv
n
+
1.46
0.99
0.95
0.63
0.64
0.1
2.55
2.51
2.19
2.2
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99404
preventive counseling indiv
n
+
1.95
1.21
1.17
0.84
0.85
0.12
3.28
3.24
2.91
2.92
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99406
behav chng smoking 3-10 min
a
0.24
0.15
0.16
0.1
0.1
0.01
0.4
0.41
0.35
0.35
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99407
behav chng smoking > 10 min
a
0.5
0.25
0.27
0.2
0.22
0.03
0.78
0.8
0.73
0.75
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99408
audit/dast 15-30 min
n
+
0.65
0.33
0.34
0.28
0.28
0.04
1.02
1.03
0.97
0.97
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99409
audit/dast over 30 min
n
+
1.3
0.6
0.62
0.55
0.57
0.08
1.98
2
1.93
1.95
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99411
preventive counseling group
n
+
0.15
0.3
0.3
0.06
0.07
0.01
0.46
0.46
0.22
0.23
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99412
preventive counseling group
n
+
0.25
0.34
0.34
0.11
0.11
0.01
0.6
0.6
0.37
0.37
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99420
health risk assessment test
n
+
0
0.29
0.28
0.29
na
0.28
na
0.01
0.3
0.29
0.3
0.29
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99429
unlisted preventive service
n
0
0
0
0
0
0
0
0
0
0
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99441
phone e/m by phys 5-10 min
n
+
0.25
0.15
0.15
0.1
0.11
0.01
0.41
0.41
0.36
0.37
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99442
phone e/m by phys 11-20 min
n
+
0.5
0.25
0.26
0.21
0.22
0.03
0.78
0.79
0.74
0.75
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99443
phone e/m by phys 21-30 min
n
+
0.75
0.35
0.36
0.32
0.33
0.05
1.15
1.16
1.12
1.13
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99444
online e/m by phys
n
0
0
0
0
0
0
0
0
0
0
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99450
basic life disability exam
n
0
0
0
0
0
0
0
0
0
0
9
xxx
0
0
0
9
9
9
9
9
33.9764
9
0
99
0
0
0
99455
work related disability exam
r
0
0
0
0
0
0
0
0
0
0
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99456
disability examination
r
0
0
0
0
0
0
0
0
0
0
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99460
init nb em per day hosp
a
1.17
0.48
na
0.55
na
0.48
0.55
0.05
1.7
1.77
1.7
1.77
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99461
init nb em per day non-fac
a
1.26
1.34
1.44
0.53
0.55
0.08
2.68
2.78
1.87
1.89
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99462
sbsq nb em per day hosp
a
0.62
0.26
na
0.29
na
0.26
0.29
0.04
0.92
0.95
0.92
0.95
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99463
same day nb discharge
a
1.5
0.75
na
0.86
na
0.75
0.86
0.08
2.33
2.44
2.33
2.44
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99464
attendance at delivery
a
1.5
0.54
na
0.59
na
0.54
0.59
0.07
2.11
2.16
2.11
2.16
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99465
nb resuscitation
a
2.93
0.93
na
0.68
na
0.93
0.68
0.22
4.08
3.83
4.08
3.83
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99466
ped crit care transport
a
4.79
1.98
na
2.23
na
1.98
2.23
1.02
7.79
8.04
7.79
8.04
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99467
ped crit care transport addl
a
2.4
0.95
na
1.05
na
0.95
1.05
0.14
3.49
3.59
3.49
3.59
0
zzz
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99468
neonate crit care initial
a
18.46
6.47
na
7.38
na
6.47
7.38
1.52
26.45
27.36
26.45
27.36
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99469
neonate crit care subsq
a
7.99
3.11
na
3.5
na
3.11
3.5
0.42
11.52
11.91
11.52
11.91
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99471
ped critical care initial
a
15.98
5.94
na
6.39
na
5.94
6.39
0.87
22.79
23.24
22.79
23.24
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99472
ped critical care subsq
a
7.99
3
na
3.28
na
3
3.28
0.48
11.47
11.75
11.47
11.75
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99475
ped crit care age 2-5 init
a
11.25
4
4.51
4
4.51
0.86
16.11
16.62
16.11
16.62
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99476
ped crit care age 2-5 subsq
a
6.75
2.49
2.89
2.49
2.89
0.52
9.76
10.16
9.76
10.16
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99477
init day hosp neonate care
a
7
2.79
na
3.07
na
2.79
3.07
0.38
10.17
10.45
10.17
10.45
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99478
ic lbw inf < 1500 gm subsq
a
2.75
1.11
na
1.1
na
1.11
1.1
0.18
4.04
4.03
4.04
4.03
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99479
ic lbw inf 1500-2500 g subsq
a
2.5
1.05
na
1.22
na
1.05
1.22
0.16
3.71
3.88
3.71
3.88
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99480
ic inf pbw 2501-5000 g subsq
a
2.4
0.9
na
0.96
na
0.9
0.96
0.16
3.46
3.52
3.46
3.52
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
99499
unlisted e&m service
c
0
0
0
0
0
0
0
0
0
0
0
xxx
0
0
0
0
0
0
0
0
33.9764
9
0
99
0
0
0
One self-limited or minor problem, e.g., cold, insect bite, tinea corporis
Two or more self-limited or minor problems
One stable chronic illness, e.g., well controlled HTN, DM2, cataract
Acute uncomplicated injury or illness, e.g., cystitis, allergic rhinitis, sprain
One or more chronic illness with mild exacerbation or progression
Two or more stable chronic illnesses
Undiagnosed new problem with uncertain prognosis (e.g., lump in breast)
Acute illness with systemic symptoms (e.g., pyelonephritis, colitis)
One or more chronic illness, with severe exacerbation or progression
Acute or chronic illness or injury, which poses a threat to life or bodily function, e.g., multiple trauma, acute MI, pulmonary embolism, severe respiratory distress, progressive severe rheumatoid arthritis, psychiatric illness, with potential threat to self or others, peritonitis, ARF
An abrupt change in neurological status, e.g., seizure, TIA, weakness, sensory loss
Laboratory tests
Chest X-rays
EKG/EEG
Urinalysis
Ultrasound/Echocardiogram
KOH prep
Physiologic tests not under stress, e.g., PFTs
Non-cardiovascular imaging studies with contrast, e.g., barium enema
Superficial needle biopsy
Physiologic tests under stress, e.g., cardiac stress test, fetal contraction stress test
Diagnostic endoscopies, with no identified risk
Deep needle, or incisional biopsies
Cardiovascular imaging studies, with contrast, with no identified risk factors, e.g., arteriogram, cardiac catheterization
Obtain fluid from body cavity, e.g., LP/thoracentesis
Cardiovascular imaging, with contrast, with identified risk factors
Cardiac EP studies
diagnosis endoscopies, with identified risk factors
Discography
Rest
Gargles
Elastic bandages
Superficial dressings
Over the counter drugs
Minor surgery, with no identified risk factors
Physical therapy
Occupational therapy
IV fluids, without additives
Minor surgery, with identified risk factors
Elective major surgery (open, percutaneous, or endoscopic), with no identified risk
Prescription drug management
Therapeutic nuclear medicine
IV fluids, with additives
Closed treatment of fracture or dislocation, without manipulation
Elective major surgery (open, percutaneous, endoscopic), with identified risk factors
Emergency major surgery (open, percutaneous, endoscopic)
Parenteral controlled substances
Drug therapy requiring intensive monitoring for toxicity
Decision not to resuscitate, or to de-escalate care because of poor prognosis