decisionhealth Newsletters, Coder Pink Sheets - 2025 Issue 3 (March)
Q&A: Avoid absolutes when selecting the level of risk for MDM
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Article Overview
This Q&A explains how risk is evaluated for E/M medical decision-making under the revised guidelines and why blanket assumptions about risk level can be misleading. It is aimed at coders, compliance staff, and clinicians who need to understand general risk-assessment principles, documentation expectations, and the broader guidance referenced by AMA/CPT sources.
Why This Topic Matters
Accurate risk assessment can affect E/M leveling, documentation support, and consistency across encounters. The article helps readers understand that risk evaluation depends on the patient, the encounter, and the provider’s documented assessment rather than absolute rules.
What You Will Learn
- How risk is considered in E/M medical decision-making
- Why risk assessment may differ by patient and encounter
- The role of provider documentation in supporting risk level selection
- How AMA/CPT guidance frames general risk-assessment expectations
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Physicians and other qualified health care professionals
- E/M documentation reviewers
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