Reader Questions: Recognize Different MDM Tables

Why This Topic Matters

Choosing the wrong medical decision-making table can lead to incorrect evaluation and management level assignment. The article helps readers understand the scope of the 2021 CPT updates, the continued presence of other CMS guidance, and why published clarification from CPT Assistant matters for accurate coding.

Article Sections

1. Question

   The reader asks about using CMS-provided examples to determine evaluation and management level for office and outpatient visit codes.

2. Answer

   The response explains which medical decision-making framework applies to the updated office and outpatient visit codes and contrasts it with other E/M guidance.

3. Discussion of Separate MDM Tables

   This section describes why CPT and CMS references can differ and how that distinction has created confusion for coders.

4. Clarification from CPT Assistant

   The article summarizes a published clarification addressing how the updated medical decision-making framework should be understood.

5. Example and Risk Comparison

   The article uses a broad surgical example to illustrate the contrast between the two approaches to assessing risk within evaluation and management guidance.

6. Shift in the Risk Element for 2021 MDM

   This section describes the broader conceptual change in how risk is framed under the updated office and outpatient medical decision-making rules.